Provider Demographics
NPI:1619267580
Name:ANGEL HOUSE OF MARION COUNTY, INC.
Entity Type:Organization
Organization Name:ANGEL HOUSE OF MARION COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:PINDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:352-369-0068
Mailing Address - Street 1:2109 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1941
Mailing Address - Country:US
Mailing Address - Phone:352-369-0068
Mailing Address - Fax:352-369-0088
Practice Address - Street 1:2109 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1941
Practice Address - Country:US
Practice Address - Phone:352-369-0068
Practice Address - Fax:352-369-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL691111196314000000X
FL691111195320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691111196Medicaid