Angus Lake Vital Care
LBN: Angus Lake Infusion Services
Angus Lake Vital Care is an health care organization with primary practice located at 240 Milledgeville Rd Suite B, Gordon GA 31031-3827. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Parenteral & Enteral Nutrition, Suppliers / Compounding Pharmacy, Suppliers / Home Infusion Therapy Pharmacy. Suppliers / Durable Medical Equipment & Medical Supplies is the primary health care specialty.
Angus Lake Infusion Services can be contacted via phone (478) 387-2399, or through Stanley, Carl Lake via phone (478) 387-2399.
Contact Information
Primary practice address
240 Milledgeville Rd Suite B
Gordon GA 31031-3827
Phone: (478) 387-2399
Fax: (478) 628-2263
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | PHHH000055 | Georgia |
| Suppliers / Parenteral & Enteral Nutrition | 332BP3500X | PHHH000055 | Georgia |
| Suppliers / Compounding Pharmacy | 3336C0004X | PHHH000055 | Georgia |
| Suppliers / Home Infusion Therapy Pharmacy | 3336H0001X | PHHH000055 | Georgia |
Profile Details
| NPI number | 1063855211 |
|---|---|
| LBN Legal business name | Angus Lake Infusion Services |
| DBA Doing business as | Angus Lake Vital Care |
| Authorized official | Stanley, Carl Lake RPH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 8th, 2013 |
| Last updated | Oct 18th, 2013 - about 11 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063855211 | NPPES |
| Georgia | MEDICAID | 003137168A |
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