Provider Demographics
NPI:1376695965
Name:ANGELS UNAWARE INC
Entity Type:Organization
Organization Name:ANGELS UNAWARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:HOLTEN
Authorized Official - Last Name:OBANION
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:813-961-1159
Mailing Address - Street 1:PO BOX 270040
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-0040
Mailing Address - Country:US
Mailing Address - Phone:813-961-1159
Mailing Address - Fax:813-265-1656
Practice Address - Street 1:4918 W LINEBAUGH AVENUE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5028
Practice Address - Country:US
Practice Address - Phone:813-961-1159
Practice Address - Fax:813-265-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024115696OtherAPB
FL024115696Medicaid