NPIMap

Organization Active NPI

Blue Angels Home Care Georgia LLC

  • In Home Supportive Care Agency
  • Norcross, GA
National Provider Identifier
1386519171
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
BLUE ANGELS HOME CARE GEORGIA LLC
Practice address
1951 Ferentz Trce
Norcross, GA 30071-3676
Phone
(770) 328-4341
Fax
(678) 495-1401
NPI assigned
Oct 9, 2025
Last updated
Oct 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Frehiwot DersoNPI 1942610829
Title
RN
Phone
(770) 328-4341

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X NU Primary

Addresses

Primary practice location

1951 Ferentz Trce
Norcross, GA 30071-3676

Mailing address

1951 Ferentz Trce
Norcross, GA 30071-3676
Phone (770) 328-4341

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1759968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759968000000",
    "number": "1386519171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1951 FERENTZ TRCE",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300713676",
            "telephone_number": "770-328-4341",
            "fax_number": "678-495-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1951 FERENTZ TRCE",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300713676",
            "telephone_number": "770-328-4341",
            "fax_number": "678-495-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE ANGELS HOME CARE GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-09",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A",
        "authorized_official_last_name": "DERSO",
        "authorized_official_first_name": "FREHIWOT",
        "authorized_official_title_or_position": "RN",
        "authorized_official_telephone_number": "770-328-4341"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norcross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.