Provider Demographics
NPI:1346731387
Name:QUEENIE'S ANGELS, LLC
Entity Type:Organization
Organization Name:QUEENIE'S ANGELS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAQUANDA
Authorized Official - Middle Name:SHAUNTA
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-667-2184
Mailing Address - Street 1:PO BOX 3392
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-3392
Mailing Address - Country:US
Mailing Address - Phone:727-667-2184
Mailing Address - Fax:
Practice Address - Street 1:6355 27TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-6395
Practice Address - Country:US
Practice Address - Phone:727-667-2184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities