Provider Demographics
NPI:1114321635
Name:ANGELA STALLING
Entity Type:Organization
Organization Name:ANGELA STALLING
Other - Org Name:ANGIE'S SPECIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:STALLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-777-0367
Mailing Address - Street 1:473 NW SELVITZ RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1033
Mailing Address - Country:US
Mailing Address - Phone:772-777-0367
Mailing Address - Fax:
Practice Address - Street 1:473 NW SELVITZ RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1033
Practice Address - Country:US
Practice Address - Phone:772-777-0367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility