Healthcare Provider Details

I. General information

NPI: 1174009021
Provider Name (Legal Business Name): ANGELCARE WITH A VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3577 FLAT CREEK RD
CHATTAHOOCHEE FL
32324
US

IV. Provider business mailing address

3577 FLAT CREEK RD
CHATTAHOOCHEE FL
32324
US

V. Phone/Fax

Practice location:
  • Phone: 850-442-4213
  • Fax:
Mailing address:
  • Phone: 850-442-4213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. TAMMY L CEASOR
Title or Position: CEO
Credential:
Phone: 850-273-3703