1174138564 NPI number — DIVINE ANGELS HOME CARE

Table of content: (NPI 1174138564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174138564 NPI number — DIVINE ANGELS HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVINE ANGELS HOME CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174138564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
970 MARTIN LUTHER KING JR DR SW # 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30314-2962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-866-0038
Provider Business Mailing Address Fax Number:
678-623-0374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
970 MARTIN LUTHER KING JR DR SW # 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30314-2962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-866-0038
Provider Business Practice Location Address Fax Number:
678-623-0374
Provider Enumeration Date:
09/11/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BADGETT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
470-469-5828

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHCP010874 . This is a "PERSONAL HOME CARE SERVICES" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".