MEDICARE: ANGELS OF JESUS

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1942772520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS OF JESUS

Provider Business Mailing Address
First Line	:	1404 N OBSERVATORY DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-5916
Country	:	US
Telephone Number	:	407-219-1740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 N OBSERVATORY DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-5916
Country	:	US
Telephone Number	:	407-219-1740
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIE ANGE AUGUSTIN
Credential	:
Telephone Number	:	407-219-1740

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	12/20/2018

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Directions to “ANGELS OF JESUS ” Practice Location

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