Provider Demographics
NPI:1275954497
Name:ANGELIKA'S COUNTRYSIDE ADULT CARE HOME
Entity Type:Organization
Organization Name:ANGELIKA'S COUNTRYSIDE ADULT CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIKA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GIECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-610-0121
Mailing Address - Street 1:12102 CROMWELL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-9640
Mailing Address - Country:US
Mailing Address - Phone:352-610-0121
Mailing Address - Fax:
Practice Address - Street 1:12102 CROMWELL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-9640
Practice Address - Country:US
Practice Address - Phone:352-610-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906571311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home