Provider Demographics
NPI:1174138564
Name:DIVINE ANGELS HOME CARE
Entity type:Organization
Organization Name:DIVINE ANGELS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-469-5828
Mailing Address - Street 1:970 MARTIN LUTHER KING JR DR SW # 2
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-2962
Mailing Address - Country:US
Mailing Address - Phone:678-866-0038
Mailing Address - Fax:678-623-0374
Practice Address - Street 1:970 MARTIN LUTHER KING JR DR SW # 2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-2962
Practice Address - Country:US
Practice Address - Phone:678-866-0038
Practice Address - Fax:678-623-0374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHCP010874OtherPERSONAL HOME CARE SERVICES