Healthcare Provider Details

I. General information

NPI: 1477813806
Provider Name (Legal Business Name): MY DARLING ANGELS HOME COMPANION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MORNINGVIEW DR
EUSTIS FL
32726
US

IV. Provider business mailing address

102 MORNINGVIEW DR
EUSTIS FL
32726
US

V. Phone/Fax

Practice location:
  • Phone: 352-602-0694
  • Fax: 352-357-1302
Mailing address:
  • Phone: 352-602-0694
  • Fax: 352-357-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number16367232603
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number1636723603
License Number StateFL

VIII. Authorized Official

Name: TARA DENISE DARLING
Title or Position: CNA/OWNER/ADMINISTRATOR
Credential:
Phone: 352-602-0694