Healthcare Provider Details

I. General information

NPI: 1790610459
Provider Name (Legal Business Name): ANGEL OF LIFE CHILDREN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NE 25TH AVE STE 104
OCALA FL
34470-5665
US

IV. Provider business mailing address

1111 NE 25TH AVE STE 104
OCALA FL
34470-5665
US

V. Phone/Fax

Practice location:
  • Phone: 347-954-1846
  • Fax:
Mailing address:
  • Phone: 347-954-1846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: TYMIKA RUSSELL
Title or Position: EXECUTIVE DIRECTOR
Credential: MS ED.
Phone: 347-954-1846