Healthcare Provider Details

I. General information

NPI: 1508783002
Provider Name (Legal Business Name): ANGEL CONCIERGE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 SW 3RD AVE
BOYNTON BEACH FL
33426-4701
US

IV. Provider business mailing address

627 SW 3RD AVE
BOYNTON BEACH FL
33426-4701
US

V. Phone/Fax

Practice location:
  • Phone: 561-528-0629
  • Fax:
Mailing address:
  • Phone: 561-528-0629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: WADELINE DERILUS
Title or Position: MGR
Credential: LPN
Phone: 561-528-0629