Provider Demographics
NPI:1780983718
Name:ANGELFORCE INC
Entity type:Organization
Organization Name:ANGELFORCE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-534-6711
Mailing Address - Street 1:112 LANE AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-3524
Mailing Address - Country:US
Mailing Address - Phone:904-534-6711
Mailing Address - Fax:904-768-0237
Practice Address - Street 1:112 LANE AVE S
Practice Address - Street 2:POST OFFICE BOX 77377
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-3524
Practice Address - Country:US
Practice Address - Phone:904-534-6711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL675103296253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL675103296OtherMEDWAIVER
FL675103296Medicaid