Provider Demographics
NPI:1467021766
Name:ANGELS FOR KIDS ON CALL 24/7 INC.
Entity Type:Organization
Organization Name:ANGELS FOR KIDS ON CALL 24/7 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-730-7983
Mailing Address - Street 1:1071 PORT MALABAR BLVD NE STE 106
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5161
Mailing Address - Country:US
Mailing Address - Phone:407-730-7983
Mailing Address - Fax:
Practice Address - Street 1:19 N 6TH ST STE 19A
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4205
Practice Address - Country:US
Practice Address - Phone:407-730-7983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELS FOR KIDS ON CALL 24/7 INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018553000Medicaid