MEDICARE: ANGEL OF LIFE CHILDREN SERVICES 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1790610459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL OF LIFE CHILDREN SERVICES LLC

Provider Business Mailing Address
First Line	:	1111 NE 25TH AVE STE 104
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-5665
Country	:	US
Telephone Number	:	347-954-1846
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 NE 25TH AVE STE 104
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-5665
Country	:	US
Telephone Number	:	347-954-1846
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TYMIKA RUSSELL
Credential	:	MS ED.
Telephone Number	:	347-954-1846

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ANGEL OF LIFE CHILDREN SERVICES LLC ” Practice Location

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