Provider Demographics
NPI:1003787326
Name:GOOD ANGELIC PRIVATE HOME CARE
Entity type:Organization
Organization Name:GOOD ANGELIC PRIVATE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PRIVATE HOME CARE
Authorized Official - Phone:478-714-2835
Mailing Address - Street 1:5811 LEONE DR W
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-8223
Mailing Address - Country:US
Mailing Address - Phone:478-714-2835
Mailing Address - Fax:
Practice Address - Street 1:5811 LEONE DR W
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-8223
Practice Address - Country:US
Practice Address - Phone:478-714-2835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty