Organization
IDELLA'S ANGELS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON LAVERNE BENNETT (OWNER)
(229) 200-4887
Entity
Organization
Contact information
Practice address
270 13TH AVE SW, CAIRO, GA 39828-3423
(229) 200-4887
Mailing address
270 13TH AVE SW, CAIRO, GA 39828-3423
(229) 200-4887
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
05/16/2020
Last updated
10/12/2021
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