MEDICARE: G.L.A.S. ANGELS CARE HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1659148476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G.L.A.S. ANGELS CARE HOME

Provider Business Mailing Address
First Line	:	496 HIGHPOINT XING
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-5112
Country	:	US
Telephone Number	:	770-313-3544
Fax Number	:

Provider Business Practice Location Address
First Line	:	496 HIGHPOINT XING
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-5112
Country	:	US
Telephone Number	:	770-313-3544
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LASHAWN BAKER
Credential	:
Telephone Number	:	770-313-3544

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	02/06/2024

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