Provider Demographics
NPI:1083917934
Name:ANGELS UNIQUE LLC.
Entity Type:Organization
Organization Name:ANGELS UNIQUE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PERGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-523-1111
Mailing Address - Street 1:13520 17TH ST
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5211
Mailing Address - Country:US
Mailing Address - Phone:352-523-1111
Mailing Address - Fax:352-523-1122
Practice Address - Street 1:13520 17TH ST
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5211
Practice Address - Country:US
Practice Address - Phone:352-523-1111
Practice Address - Fax:352-523-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
FL230477253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001856800Medicaid
FL680166801Medicaid
FL680166896Medicaid
FL680166898Medicaid