Provider Demographics
NPI:1568164457
Name:ANGELIC EXPERIENCE HOME CARE LLC
Entity Type:Organization
Organization Name:ANGELIC EXPERIENCE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-328-8762
Mailing Address - Street 1:2241 N MONROE ST # 1475
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4731
Mailing Address - Country:US
Mailing Address - Phone:850-328-8762
Mailing Address - Fax:
Practice Address - Street 1:5177 WATER VALLEY DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-8920
Practice Address - Country:US
Practice Address - Phone:850-328-8762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty