| Organization Name: | HEAVENLY ANGELS HOME OF CARE PCH, LLC |
| NPI Number: | 1942561717 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AYANNA R BROWN (CEO) |
| Mailing Address: | 5530 Swanson Rd Ellenwood |
| State: | GA US |
| Postal Code: | 302943857 |
| Phone Number: | 4043618485 |
| Fax Number: | 4043939382 |
| NPI Enumeration Date: | 06/07/2012 |
| NPI Last Update Date: | 06/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320700000X |
| License Number: | PCH006734 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |