Provider Demographics
NPI:1740573112
Name:AN ANGELS TOUCH HOMEMAKER COMPANION CARE
Entity Type:Organization
Organization Name:AN ANGELS TOUCH HOMEMAKER COMPANION CARE
Other - Org Name:AN ANGELS TOUCH HOMEMAAKER & COMPANION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER.ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:MURRELL-HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-325-5630
Mailing Address - Street 1:2527 ANNAPOLIS WAY APT 109
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2344
Mailing Address - Country:US
Mailing Address - Phone:813-325-5630
Mailing Address - Fax:813-441-8679
Practice Address - Street 1:6205 TRAVIS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-5501
Practice Address - Country:US
Practice Address - Phone:813-325-5630
Practice Address - Fax:813-441-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL830703305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01195301Medicaid