Healthcare Provider Details

I. General information

NPI: 1184904021
Provider Name (Legal Business Name): ANGEL'S WINGS OF LOVE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S ADELLE AVE SUITE B
DELAND FL
32720-7326
US

IV. Provider business mailing address

PO BOX 3891
DELAND FL
32721-3891
US

V. Phone/Fax

Practice location:
  • Phone: 386-960-6504
  • Fax:
Mailing address:
  • Phone: 386-960-6504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number003813600
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number003813600
License Number StateFL

VIII. Authorized Official

Name: MRS. JOY BRINSON
Title or Position: PRESIDENT-OWNER
Credential:
Phone: 386-631-8197