Provider Demographics
NPI:1508120718
Name:ANGELS OF HOPE COMPANION SERVICES LLC
Entity Type:Organization
Organization Name:ANGELS OF HOPE COMPANION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARLINDA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:HOMEMAKER/COMPANION
Authorized Official - Phone:904-300-3189
Mailing Address - Street 1:3501 TOWNSEND BLVD APT 134
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2716
Mailing Address - Country:US
Mailing Address - Phone:904-300-3189
Mailing Address - Fax:
Practice Address - Street 1:3501 TOWNSEND BLVD APT 134
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2716
Practice Address - Country:US
Practice Address - Phone:904-300-3189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL231943251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003473900Medicaid