Provider Demographics
NPI:1932819711
Name:ANGELES DE AMOR LLC
Entity Type:Organization
Organization Name:ANGELES DE AMOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISANKYS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-387-0687
Mailing Address - Street 1:11310 SW 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6675
Mailing Address - Country:US
Mailing Address - Phone:305-387-0687
Mailing Address - Fax:786-227-6963
Practice Address - Street 1:11310 SW 145TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6675
Practice Address - Country:US
Practice Address - Phone:305-387-0687
Practice Address - Fax:786-227-6963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11244OtherAHCA