Healthcare Provider Details

I. General information

NPI: 1689539157
Provider Name (Legal Business Name): WILLIE & ESSIE ANGELS OF HEAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 PRESTON PINES TRL
JACKSONVILLE FL
32244-4439
US

IV. Provider business mailing address

7280 PRESTON PINES TRL
JACKSONVILLE FL
32244-4439
US

V. Phone/Fax

Practice location:
  • Phone: 904-401-3116
  • Fax:
Mailing address:
  • Phone: 904-401-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: JOANN MCFADDEN
Title or Position: OWNER
Credential:
Phone: 904-401-3116