Provider Demographics
NPI:1093402448
Name:COMFORTING ANGEL LLC
Entity Type:Organization
Organization Name:COMFORTING ANGEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-333-5134
Mailing Address - Street 1:981 HIGHWAY 98 E STE 3
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2525
Mailing Address - Country:US
Mailing Address - Phone:850-333-1942
Mailing Address - Fax:
Practice Address - Street 1:93 DUNE LAKES CIR # L2201
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-8393
Practice Address - Country:US
Practice Address - Phone:850-333-1942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care