Healthcare Provider Details

I. General information

NPI: 1033493978
Provider Name (Legal Business Name): CITY OF ANGELS HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13170 SW 128TH ST SUITE 200
MIAMI FL
33186-5845
US

IV. Provider business mailing address

13170 SW 128TH ST SUITE 200
MIAMI FL
33186-5845
US

V. Phone/Fax

Practice location:
  • Phone: 305-971-6363
  • Fax: 305-971-6365
Mailing address:
  • Phone: 305-971-6363
  • Fax: 305-971-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299992682
License Number StateFL

VIII. Authorized Official

Name: MICHAEL C TRUTT
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-971-6363