Provider Demographics
NPI:1033493978
Name:CITY OF ANGELS HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:CITY OF ANGELS HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:TRUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-971-6363
Mailing Address - Street 1:13170 SW 128TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5845
Mailing Address - Country:US
Mailing Address - Phone:305-971-6363
Mailing Address - Fax:305-971-6365
Practice Address - Street 1:13170 SW 128TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5845
Practice Address - Country:US
Practice Address - Phone:305-971-6363
Practice Address - Fax:305-971-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992682251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health