Healthcare Provider Details

I. General information

NPI: 1972121689
Provider Name (Legal Business Name): ANGEL OF LIFE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15576 SW 46TH CIR
OCALA FL
34473-3181
US

IV. Provider business mailing address

15576 SW 46TH CIR
OCALA FL
34473-3181
US

V. Phone/Fax

Practice location:
  • Phone: 352-553-9870
  • Fax:
Mailing address:
  • Phone: 352-553-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MR. EUGENE PORTER JR.
Title or Position: OFFICER
Credential:
Phone: 352-553-9870