Provider Demographics
NPI:1598419459
Name:STONE'S ANGEL CARE, LLC
Entity Type:Organization
Organization Name:STONE'S ANGEL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WAIVER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:K
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-678-5277
Mailing Address - Street 1:12922 SAULSTON PL
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-5049
Mailing Address - Country:US
Mailing Address - Phone:352-678-5277
Mailing Address - Fax:
Practice Address - Street 1:16319 DINSDALE DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-6519
Practice Address - Country:US
Practice Address - Phone:352-678-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002326500Medicaid