Provider Demographics
NPI:1033462197
Name:NURSING CARE BY ANGELS
Entity Type:Organization
Organization Name:NURSING CARE BY ANGELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-299-7687
Mailing Address - Street 1:8085 BABCOCK ST SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-5910
Mailing Address - Country:US
Mailing Address - Phone:321-345-4774
Mailing Address - Fax:321-914-0712
Practice Address - Street 1:8085 BABCOCK ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-5910
Practice Address - Country:US
Practice Address - Phone:321-345-4774
Practice Address - Fax:321-914-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12241310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142640100Medicaid