# HEAVENLY ANGELS HOME OF CARE PCH, LLC

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

## Provider details

- **NPI number:** 1942561717
- **Authorized official:** MS. AYANNA R BROWN (CEO)
- **Authorized official phone:** (404) 361-8485

## Contact information

- **Practice address:** 5530 SWANSON RD, ELLENWOOD, GA 30294-3857
- **Practice address phone:** (404) 361-8485
- **Practice address fax:** (404) 393-9382
- **Mailing address:** 5369 SAND BAR LN, COLLEGE PARK, GA 30349-3058
- **Mailing address phone:** (404) 361-8485
- **Mailing address fax:** (404) 393-9382

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | PCH006734 | GA | Yes |
| 320700000X | Physical Disabilities Residential Treatment Facility | PCH006734 | GA | — |

## Other

- **Enumeration date:** 06/07/2012
- **Last updated:** 06/07/2012