| Organization Name: | PURE ANGELS HOME CARE SERVICES |
| NPI Number: | 1104245034 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHIRLEY J BRESHERS-SOUTHWELL (OWNER) |
| Mailing Address: | 5300 Memorial Dr Suite 134 Stone Mountain |
| State: | GA US |
| Postal Code: | 300833148 |
| Phone Number: | 4045005425 |
| Fax Number: | 4045005427 |
| NPI Enumeration Date: | 04/08/2014 |
| NPI Last Update Date: | 04/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | 044-R-1261 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |