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Organization
HEAVENLY ANGELS HOME OF CARE PCH, LLC
Active
Organization
HEAVENLY ANGELS HOME OF CARE PCH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AYANNA R BROWN (CEO)
(404) 361-8485
Entity
Organization
Contact information
Practice address
5530 SWANSON RD, ELLENWOOD, GA 30294-3857
(404) 361-8485
(404) 393-9382
Mailing address
5369 SAND BAR LN, COLLEGE PARK, GA 30349-3058
(404) 361-8485
(404) 393-9382
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
PCH006734
GA
320700000X
Physical Disabilities Residential Treatment Facility
PCH006734
GA
Other
Enumeration date
06/07/2012
Last updated
06/07/2012
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