Provider Demographics
NPI:1184349185
Name:EARTH ANGELS HEALTH & WELLNESS, LLC
Entity type:Organization
Organization Name:EARTH ANGELS HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEGA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:904-729-5242
Mailing Address - Street 1:PO BOX 28585
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-8585
Mailing Address - Country:US
Mailing Address - Phone:904-729-5242
Mailing Address - Fax:904-765-3155
Practice Address - Street 1:10177 LANCASHIRE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-4367
Practice Address - Country:US
Practice Address - Phone:904-729-5242
Practice Address - Fax:904-765-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care