Provider Demographics
NPI:1538623996
Name:ANGEL OF MINE HOME HEALTH LLC
Entity type:Organization
Organization Name:ANGEL OF MINE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMENET
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-402-1144
Mailing Address - Street 1:11101 BENJAMIN PL
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2768
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11101 BENJAMIN PL
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-2768
Practice Address - Country:US
Practice Address - Phone:804-402-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health