Provider Demographics
NPI:1871610535
Name:ANGELS OF MERCY PRIVATE HOMECARE SERVICES, INC.
Entity type:Organization
Organization Name:ANGELS OF MERCY PRIVATE HOMECARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZANDREA
Authorized Official - Middle Name:JENEAN
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:478-738-0095
Mailing Address - Street 1:776 BACONSFIELD DR
Mailing Address - Street 2:BLDG. 2 STE. 107
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1492
Mailing Address - Country:US
Mailing Address - Phone:478-738-0095
Mailing Address - Fax:478-738-0095
Practice Address - Street 1:776 BACONSFIELD DR
Practice Address - Street 2:BLDG. 2 STE. 107
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1492
Practice Address - Country:US
Practice Address - Phone:478-738-0095
Practice Address - Fax:478-738-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011-R-0033251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health