Provider Demographics
NPI:1104245034
Name:PURE ANGELS HOME CARE SERVICES
Entity type:Organization
Organization Name:PURE ANGELS HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRESHERS-SOUTHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-500-5425
Mailing Address - Street 1:5300 MEMORIAL DR
Mailing Address - Street 2:SUITE 134
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3148
Mailing Address - Country:US
Mailing Address - Phone:404-500-5425
Mailing Address - Fax:404-500-5427
Practice Address - Street 1:5300 MEMORIAL DR
Practice Address - Street 2:SUITE 134
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3148
Practice Address - Country:US
Practice Address - Phone:404-500-5425
Practice Address - Fax:404-500-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-R-1261253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care