Provider Demographics
NPI:1124641709
Name:ANGELIC HANDS HOUSE CALLS
Entity type:Organization
Organization Name:ANGELIC HANDS HOUSE CALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:FNPC
Authorized Official - Phone:601-906-0130
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-0165
Mailing Address - Country:US
Mailing Address - Phone:601-906-0130
Mailing Address - Fax:601-667-3508
Practice Address - Street 1:299 W PEACE ST STE B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4325
Practice Address - Country:US
Practice Address - Phone:601-906-0130
Practice Address - Fax:601-667-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03820257Medicaid