Provider Demographics
NPI:1700837572
Name:CARESERVICES OF THE EMERALD COAST
Entity Type:Organization
Organization Name:CARESERVICES OF THE EMERALD COAST
Other - Org Name:ANGELS CARE HOME HEALTH OF THE EMERALD COAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:W
Authorized Official - Last Name:EDDINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-469-6739
Mailing Address - Street 1:2301 HIGHWAY 1187
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6124
Mailing Address - Country:US
Mailing Address - Phone:817-469-6739
Mailing Address - Fax:817-801-3486
Practice Address - Street 1:348 MIRACLE STRIP PKWY SW STE 10
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5257
Practice Address - Country:US
Practice Address - Phone:850-862-5424
Practice Address - Fax:850-862-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID
108181Medicare UPIN
FL108181Medicare Oscar/Certification