Provider Demographics
NPI:1720792856
Name:MY OWN ANGELS LLC
Entity Type:Organization
Organization Name:MY OWN ANGELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNEEQUA
Authorized Official - Middle Name:LATOYA MARIE
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-801-0393
Mailing Address - Street 1:10762 MAREEBA RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-9403
Mailing Address - Country:US
Mailing Address - Phone:904-801-0393
Mailing Address - Fax:904-212-1821
Practice Address - Street 1:13475 ATLANTIC BLVD STE 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3290
Practice Address - Country:US
Practice Address - Phone:904-908-7523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health