Healthcare Provider Details

I. General information

NPI: 1922564319
Provider Name (Legal Business Name): ANGLIN PREMIER CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 BATES RD
HAINES CITY FL
33844-6412
US

IV. Provider business mailing address

995 BATES RD
HAINES CITY FL
33844-6412
US

V. Phone/Fax

Practice location:
  • Phone: 863-604-4591
  • Fax:
Mailing address:
  • Phone: 863-604-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARYE ANGLIN
Title or Position: OWNER
Credential: RN
Phone: 863-604-4591