Provider Demographics
NPI:1760052302
Name:A HEART OF AN ANGEL LLC
Entity Type:Organization
Organization Name:A HEART OF AN ANGEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MRG
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATOSHA
Authorized Official - Middle Name:CATRICE
Authorized Official - Last Name:HARRIS-IVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:140-778-1686
Mailing Address - Street 1:7060 SCRUBOAK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-5247
Mailing Address - Country:US
Mailing Address - Phone:407-781-6866
Mailing Address - Fax:
Practice Address - Street 1:7060 SCRUBOAK LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-5247
Practice Address - Country:US
Practice Address - Phone:407-781-6866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty