Provider Demographics
NPI:1982119558
Name:BLUE ANGEL GARDENS CORP
Entity Type:Organization
Organization Name:BLUE ANGEL GARDENS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AUSSENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-598-7711
Mailing Address - Street 1:3921 W COMANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5619
Mailing Address - Country:US
Mailing Address - Phone:813-598-7711
Mailing Address - Fax:
Practice Address - Street 1:3921 W COMANCHE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5619
Practice Address - Country:US
Practice Address - Phone:813-598-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness