Provider Demographics
NPI:1588215578
Name:ANGEL EYES HOME CARE LLC
Entity Type:Organization
Organization Name:ANGEL EYES HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAIRCIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:638-944-6977
Mailing Address - Street 1:PO BOX 971
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:FL
Mailing Address - Zip Code:33849-0971
Mailing Address - Country:US
Mailing Address - Phone:863-733-5336
Mailing Address - Fax:
Practice Address - Street 1:1500 LAKELAND HILLS BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3257
Practice Address - Country:US
Practice Address - Phone:863-733-5336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-22
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health