Provider Demographics
NPI:1316570609
Name:ANGELS ON EARTH SENIOR SERVICE
Entity Type:Organization
Organization Name:ANGELS ON EARTH SENIOR SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-728-3413
Mailing Address - Street 1:2211 YAUPON DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3918
Mailing Address - Country:US
Mailing Address - Phone:305-240-2741
Mailing Address - Fax:
Practice Address - Street 1:2211 YAUPON DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-3918
Practice Address - Country:US
Practice Address - Phone:850-895-3891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-15
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home