Provider Demographics
NPI:1992404131
Name:ANNOINTED ANGELS HOMECARE LLC
Entity type:Organization
Organization Name:ANNOINTED ANGELS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-777-1917
Mailing Address - Street 1:112 DALTON DR
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-7340
Mailing Address - Country:US
Mailing Address - Phone:678-777-1917
Mailing Address - Fax:800-214-0277
Practice Address - Street 1:223 VANN AVE
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-3124
Practice Address - Country:US
Practice Address - Phone:678-777-1917
Practice Address - Fax:800-214-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care