Healthcare Provider Details

I. General information

NPI: 1619349347
Provider Name (Legal Business Name): ANGELS ON ASSIGNMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5773 N SALT RD
MONTICELLO FL
32344-5173
US

IV. Provider business mailing address

5773 N SALT RD
MONTICELLO FL
32344-5173
US

V. Phone/Fax

Practice location:
  • Phone: 850-544-3045
  • Fax:
Mailing address:
  • Phone: 850-544-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberP623-167-59-760-0
License Number StateFL

VIII. Authorized Official

Name: MRS. DERYLENE G. PROCTOR
Title or Position: OWNER
Credential: M.S.
Phone: 850-544-3045