Provider Demographics
NPI:1437332095
Name:HOLY ANGEL RETIREMENT LIVING AND CARE INC.
Entity Type:Organization
Organization Name:HOLY ANGEL RETIREMENT LIVING AND CARE INC.
Other - Org Name:TANGERINE COVE OF BROOKSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PIER
Authorized Official - Middle Name:
Authorized Official - Last Name:GASMENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-688-1196
Mailing Address - Street 1:747 BON AIR ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4631
Mailing Address - Country:US
Mailing Address - Phone:863-688-1196
Mailing Address - Fax:863-687-7707
Practice Address - Street 1:307 HOWELL AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2039
Practice Address - Country:US
Practice Address - Phone:352-796-3276
Practice Address - Fax:352-754-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL# 76223104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness