MEDICARE: SKY ANGEL NURSES INC

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	251E00000X	Home Health Agency	060-R-0082	GA

General Provider Information

NPI Number	:	1972600963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKY ANGEL NURSES INC

Provider Business Mailing Address
First Line	:	3060 PHARR COURT NORTH NW
Second Line	:	SUITE 12
City	:	ATLANTA
State	:	GA
Zip	:	30305-2052
Country	:	US
Telephone Number	:	404-365-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 PHARR COURT NORTH NW
Second Line	:	SUITE 12
City	:	ATLANTA
State	:	GA
Zip	:	30305-2052
Country	:	US
Telephone Number	:	404-365-0203
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. BABATUNDE B KUKU
Credential	:
Telephone Number	:	404-365-0203

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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