Provider Demographics
NPI:1760864276
Name:ANGELS HEARTS LLC
Entity type:Organization
Organization Name:ANGELS HEARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFICATE
Authorized Official - Phone:337-519-6126
Mailing Address - Street 1:604 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-5502
Mailing Address - Country:US
Mailing Address - Phone:337-321-9424
Mailing Address - Fax:337-214-2012
Practice Address - Street 1:604 CENTER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-5502
Practice Address - Country:US
Practice Address - Phone:337-321-9424
Practice Address - Fax:337-214-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACERTIFICATE103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty