Provider Demographics
NPI:1700265725
Name:DEDICATED ANGEL, INC.
Entity Type:Organization
Organization Name:DEDICATED ANGEL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GASPARINI
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE REGISTRY
Authorized Official - Phone:727-645-5450
Mailing Address - Street 1:7645 CITA LANE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653
Mailing Address - Country:US
Mailing Address - Phone:727-389-2953
Mailing Address - Fax:727-233-0651
Practice Address - Street 1:7645 CITA LN UNIT 101
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6220
Practice Address - Country:US
Practice Address - Phone:727-389-2953
Practice Address - Fax:727-233-0651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEDICATED ANGEL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211629311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home