Healthcare Provider Details

I. General information

NPI: 1669871166
Provider Name (Legal Business Name): ANGEL HEART SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18901 SW 106TH AVE A111
CUTLER BAY FL
33157-7661
US

IV. Provider business mailing address

18901 SW 106TH AVE A111
CUTLER BAY FL
33157-7661
US

V. Phone/Fax

Practice location:
  • Phone: 305-232-5330
  • Fax: 305-359-9221
Mailing address:
  • Phone: 305-232-5330
  • Fax: 305-359-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number688830501
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number6888305901
License Number StateFL

VIII. Authorized Official

Name: EARTHA MAYS
Title or Position: DIRECTOR
Credential:
Phone: 305-232-5330