Provider Demographics
NPI:1568974962
Name:ANGELS FOR LIFE HOME CARE,LLC,
Entity Type:Organization
Organization Name:ANGELS FOR LIFE HOME CARE,LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANGEL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FEITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-452-7723
Mailing Address - Street 1:11365 SW 160TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4281
Mailing Address - Country:US
Mailing Address - Phone:786-312-0173
Mailing Address - Fax:
Practice Address - Street 1:11365 SW 160TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4281
Practice Address - Country:US
Practice Address - Phone:786-452-7723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018464800Medicaid