Provider Demographics
NPI:1013375971
Name:AMY'S ANGELS HEALTH CARE, INC.
Entity Type:Organization
Organization Name:AMY'S ANGELS HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMADA
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-391-0695
Mailing Address - Street 1:92300 OVERSEAS HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2726
Mailing Address - Country:US
Mailing Address - Phone:305-771-7059
Mailing Address - Fax:
Practice Address - Street 1:92300 OVERSEAS HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2726
Practice Address - Country:US
Practice Address - Phone:305-771-7059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018989500Medicaid
FL018989503Medicaid
FL018989501Medicaid