Organization
ANGEL PRIVATE DUTY HOMECARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUNTAI GREER (ADMINSTRATOR)
(901) 857-8143
Entity
Organization
Contact information
Practice address
160 CLAIREMONT AVE STE 200, DECATUR, GA 30030-2546
(678) 954-5717
(678) 954-5801
Mailing address
160 CLAIREMONT AVE STE 200, DECATUR, GA 30030-2546
(678) 954-5717
(678) 954-5801
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
033R1625
GA
251J00000X
Nursing Care Agency
033R1625
GA
253Z00000X
In Home Supportive Care Agency
033R1625
GA
Other
Enumeration date
11/03/2016
Last updated
01/05/2017
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