Heavenly Angels Home of Care PCH, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

PCH006734 Issued in GA

Legal business name

HEAVENLY ANGELS HOME OF CARE PCH, LLC

Practice address

5530 Swanson Rd
Ellenwood, GA 30294-3857

Phone

(404) 361-8485

Fax

(404) 393-9382

NPI assigned

Jun 7, 2012

Last updated

Jun 7, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Ayanna R Brown

Title

Ceo

Phone

(404) 361-8485

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1339027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339027200000",
    "number": "1942561717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5369 SAND BAR LN",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303493058",
            "telephone_number": "404-361-8485",
            "fax_number": "404-393-9382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5530 SWANSON RD",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302943857",
            "telephone_number": "404-361-8485",
            "fax_number": "404-393-9382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVENLY ANGELS HOME OF CARE PCH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-07",
        "last_updated": "2012-06-07",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "AYANNA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-361-8485",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "PCH006734",
            "primary": true
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "GA",
            "license": "PCH006734",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kamica Ross Hatchett, CRNA
• Lenora Hawkins
• Dwight D Hayes, PHARM D
• Abosede Haygood
• Kathleen C Haynes, FNP
• Naomi Hemphill, LCSW
• Vonda S Hendrickson, LMT
• Tennille Morris Hicks, FNP-BC
• High Level Home Care LLC
• Darnyce House Hill, LCSW

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Ellenwood, GA
• Providers in Ellenwood, GA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2012; 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.