Provider Demographics
NPI:1972008951
Name:ANGELS OF LOVE HOMEMAKER & COMPANION SERVICE LLC
Entity Type:Organization
Organization Name:ANGELS OF LOVE HOMEMAKER & COMPANION SERVICE LLC
Other - Org Name:ANGELS OF LOVE HOMEMAKER & COMPANION SERVICE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:HOME HEALTH
Authorized Official - Phone:352-875-1041
Mailing Address - Street 1:PO BOX 493832
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-3832
Mailing Address - Country:US
Mailing Address - Phone:352-875-1041
Mailing Address - Fax:352-365-0271
Practice Address - Street 1:2808 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3209
Practice Address - Country:US
Practice Address - Phone:352-875-1041
Practice Address - Fax:352-431-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019371200Medicaid