Provider Demographics
NPI:1144960154
Name:ANGELS COURT LLC
Entity type:Organization
Organization Name:ANGELS COURT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY-ANN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-458-6270
Mailing Address - Street 1:1546 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-4011
Mailing Address - Country:US
Mailing Address - Phone:678-458-6270
Mailing Address - Fax:
Practice Address - Street 1:1546 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-4011
Practice Address - Country:US
Practice Address - Phone:678-458-6270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care