Provider Demographics
NPI:1326416215
Name:VISITING ANGELS
Entity Type:Organization
Organization Name:VISITING ANGELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCHMANKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-302-7560
Mailing Address - Street 1:2064 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3810
Mailing Address - Country:US
Mailing Address - Phone:904-302-7560
Mailing Address - Fax:904-352-2357
Practice Address - Street 1:2064 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3810
Practice Address - Country:US
Practice Address - Phone:904-302-7560
Practice Address - Fax:904-352-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994100251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2999994100OtherHOME HEALTH AGENCY
FL251E00000XOtherTAXONOMY