Provider Demographics
NPI:1144956343
Name:ANGELS SQUAD HOME HEALTH, LLC
Entity type:Organization
Organization Name:ANGELS SQUAD HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:NWABOGOR
Authorized Official - Last Name:OKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-641-3075
Mailing Address - Street 1:239 SWEET CANE TRL
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4143
Mailing Address - Country:US
Mailing Address - Phone:404-944-7971
Mailing Address - Fax:
Practice Address - Street 1:4296 MEMORIAL DR STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1227
Practice Address - Country:US
Practice Address - Phone:470-641-3075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care