# IDELLA'S ANGELS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114549763
- **Authorized official:** SHARON LAVERNE BENNETT (OWNER)
- **Authorized official phone:** (229) 200-4887

## Contact information

- **Practice address:** 270 13TH AVE SW, CAIRO, GA 39828-3423
- **Practice address phone:** (229) 200-4887
- **Mailing address:** 270 13TH AVE SW, CAIRO, GA 39828-3423
- **Mailing address phone:** (229) 200-4887

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 05/16/2020
- **Last updated:** 10/12/2021