Provider Demographics
NPI:1467997833
Name:GRACE ANGEL CARE LLC
Entity Type:Organization
Organization Name:GRACE ANGEL CARE LLC
Other - Org Name:GRACE ANGEL CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:P
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:352-226-1298
Mailing Address - Street 1:15108 NW 25TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-5011
Mailing Address - Country:US
Mailing Address - Phone:352-226-1298
Mailing Address - Fax:
Practice Address - Street 1:15108 NW 25TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-5011
Practice Address - Country:US
Practice Address - Phone:352-226-1298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services