MEDICARE: ANGEL'S SENIOR LIVING II, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	ALF13130	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619463007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL'S SENIOR LIVING II, LLC

Provider Business Mailing Address
First Line	:	5855 BOGGS FORD RD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-5870
Country	:	US
Telephone Number	:	386-527-5918
Fax Number	:

Provider Business Practice Location Address
First Line	:	5855 BOGGS FORD RD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-5870
Country	:	US
Telephone Number	:	386-527-5918
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. TINA MARIE CARLYLE
Credential	:
Telephone Number	:	386-527-5918

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	04/11/2019

Similar Medicare Providers

1174798433 — ORANGE COUNTY NEWBORN MEDICARE CARE PC
Practice Location Address:

3 SAINT STEPHENS PL , SUITE 2
WARWICK, NY
10990-3208

Practice Phone: 845-987-9700
Practice Fax:

1154970960 — KASSONDRA GRACE HEMMEN AU.D.
Practice Location Address:

3840 S NOVA RD STE B1
PORT ORANGE, FL
32127-4244

Practice Phone: 386-756-8225
Practice Fax: 386-767-0742

1558798405 — NORTHEAST FLORIDA PSYCHIATRIC ASSOCIATION, INC
Practice Location Address:

804 DUNLAWTON AVE STE 1
PORT ORANGE, FL
32127-4931

Practice Phone: 386-767-8584
Practice Fax: 386-767-8536

1407485188 — MARIE DENISE DESIR P.A
Practice Location Address:

3890 TURTLE CREEK DR STE C
PORT ORANGE, FL
32127-9352

Practice Phone: 386-756-4400
Practice Fax:

1184093262 — ATLANTIC AUDIOLOGY, LLC
Practice Location Address:

3840 S NOVA RD STE B1
PORT ORANGE, FL
32127-4244

Practice Phone: 386-756-8225
Practice Fax: 386-767-0742

1053298125 — JAMIE MARANDO HIS
Practice Location Address:

1680 DUNLAWTON AVE
PORT ORANGE, FL
32127-4754

Practice Phone: 386-756-8225
Practice Fax: 386-767-0742

Directions to “ANGEL'S SENIOR LIVING II, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.