Healthcare Provider Details

I. General information

NPI: 1871124792
Provider Name (Legal Business Name): ANGEL'S COMPANION SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 BRIGHTLEAF CIR
CANTONMENT FL
32533-7880
US

IV. Provider business mailing address

1771 BRIGHTLEAF CIR
CANTONMENT FL
32533-7880
US

V. Phone/Fax

Practice location:
  • Phone: 850-288-5264
  • Fax:
Mailing address:
  • Phone: 850-288-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. VONCILLA LUQITA KYLES
Title or Position: OWNER
Credential:
Phone: 850-288-5264