Healthcare Provider Details

I. General information

NPI: 1366857484
Provider Name (Legal Business Name): SYERRA'S ANGELS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ALMOND PL 8 ALMOND PL
OCALA FL
34472-9411
US

IV. Provider business mailing address

10 ALMOND PL 8 ALMOND PL
OCALA FL
34472-9411
US

V. Phone/Fax

Practice location:
  • Phone: 352-509-2294
  • Fax: 352-509-2086
Mailing address:
  • Phone: 352-509-2294
  • Fax: 352-509-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL12707
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906684
License Number StateFL

VIII. Authorized Official

Name: MRS. JUNE NATASHA PHIFER
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-509-2294