Provider Demographics
NPI:1669771572
Name:ANGELS GARDEN ACLF INC
Entity type:Organization
Organization Name:ANGELS GARDEN ACLF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:VICE PRESIDENT
Authorized Official - Phone:813-933-4585
Mailing Address - Street 1:8003 N ROME AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-3820
Mailing Address - Country:US
Mailing Address - Phone:813-933-4585
Mailing Address - Fax:813-933-3785
Practice Address - Street 1:8003 N ROME AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-3820
Practice Address - Country:US
Practice Address - Phone:813-933-4585
Practice Address - Fax:813-933-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient