Provider Demographics
NPI:1861679037
Name:ANGELES RESIDENTIAL, INC.
Entity Type:Organization
Organization Name:ANGELES RESIDENTIAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIANAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-718-9134
Mailing Address - Street 1:6341 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2684
Mailing Address - Country:US
Mailing Address - Phone:305-825-0262
Mailing Address - Fax:305-500-7014
Practice Address - Street 1:6341 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2684
Practice Address - Country:US
Practice Address - Phone:305-825-0262
Practice Address - Fax:305-500-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9146310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140107600Medicaid
FL008110500Medicaid
FL682061100Medicaid