Healthcare Provider Details

I. General information

NPI: 1578369906
Provider Name (Legal Business Name): LITTLE ANGELS PEDIATRIC EXTENDED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 W ORANGE BLOSSOM TRL
APOPKA FL
32712-3482
US

IV. Provider business mailing address

1400 W STATE ROAD 434 STE 1000
LONGWOOD FL
32750-3817
US

V. Phone/Fax

Practice location:
  • Phone: 407-403-5822
  • Fax: 407-403-5818
Mailing address:
  • Phone: 407-403-5822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DANEIQUA HAMILTON
Title or Position: COO
Credential:
Phone: 407-403-5822