MEDICARE: ANGEL HOUSE

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		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	:	1629373410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL HOUSE

Provider Business Mailing Address
First Line	:	10810 NW 20TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-2224
Country	:	US
Telephone Number	:	954-483-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	10810 NW 20TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-2224
Country	:	US
Telephone Number	:	954-483-7300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DOREEN CAMPBELL
Credential	:
Telephone Number	:	954-483-7300

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	01/26/2011

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Directions to “ANGEL HOUSE ” Practice Location

Language	Start Address	Practice Location

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