Provider Demographics
NPI:1922564319
Name:ANGLIN PREMIER CARE LLC.
Entity Type:Organization
Organization Name:ANGLIN PREMIER CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:863-604-4591
Mailing Address - Street 1:995 BATES RD
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6412
Mailing Address - Country:US
Mailing Address - Phone:863-604-4591
Mailing Address - Fax:
Practice Address - Street 1:995 BATES RD
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-6412
Practice Address - Country:US
Practice Address - Phone:863-604-4591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024849700Medicaid
FL021272600Medicaid