Healthcare Provider Details

I. General information

NPI: 1801489851
Provider Name (Legal Business Name): ANGEL HEART HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 HANCOCK BRIDGE PKWY UNIT 1
CAPE CORAL FL
33990-1238
US

IV. Provider business mailing address

1015 HANCOCK BRIDGE PKWY UNIT 1
CAPE CORAL FL
33990-1238
US

V. Phone/Fax

Practice location:
  • Phone: 239-599-4192
  • Fax: 239-800-3134
Mailing address:
  • Phone: 239-599-4192
  • Fax: 239-800-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ISMAELLE MANUEL
Title or Position: OWNER
Credential:
Phone: 954-470-1259