Provider Demographics
NPI:1215076039
Name:ANGEL HOMEMAKER SERVICES, LLC
Entity type:Organization
Organization Name:ANGEL HOMEMAKER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-3785
Mailing Address - Street 1:200 GLASSCO ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-4434
Mailing Address - Country:US
Mailing Address - Phone:662-843-3785
Mailing Address - Fax:662-843-3401
Practice Address - Street 1:200 GLASSCO ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-4434
Practice Address - Country:US
Practice Address - Phone:662-843-3785
Practice Address - Fax:662-843-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Not Answered376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Not Answered385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08458322Medicaid
MS00770576Medicaid
MS04632279Medicaid