Provider Demographics
NPI:1275731549
Name:CARING ANGELS ON GUARD, INC.
Entity Type:Organization
Organization Name:CARING ANGELS ON GUARD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELECIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:352-346-5855
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-0088
Mailing Address - Country:US
Mailing Address - Phone:352-346-5855
Mailing Address - Fax:352-729-2508
Practice Address - Street 1:333 W ALFRED ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3205
Practice Address - Country:US
Practice Address - Phone:352-346-5855
Practice Address - Fax:352-729-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233036251E00000X
FL008951900320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008951900Medicaid