Healthcare Provider Details

I. General information

NPI: 1619267580
Provider Name (Legal Business Name): ANGEL HOUSE OF MARION COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 SW 7TH ST
OCALA FL
34471-1941
US

IV. Provider business mailing address

2109 SW 7TH ST
OCALA FL
34471-1941
US

V. Phone/Fax

Practice location:
  • Phone: 352-369-0068
  • Fax: 352-369-0088
Mailing address:
  • Phone: 352-369-0068
  • Fax: 352-369-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number691111196
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number691111195
License Number StateFL

VIII. Authorized Official

Name: MRS. DAISY PINDER
Title or Position: REGISTERED NURSE
Credential: R.N.
Phone: 352-369-0068