Healthcare Provider Details

I. General information

NPI: 1184472367
Provider Name (Legal Business Name): ANGELIC DOVE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2024
Last Update Date: 05/11/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 LILAC LN APT 122
PENSACOLA FL
32514-7669
US

IV. Provider business mailing address

7840 LILAC LN APT 122
PENSACOLA FL
32514-7669
US

V. Phone/Fax

Practice location:
  • Phone: 850-288-7098
  • Fax:
Mailing address:
  • Phone: 850-288-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. DOVELINE H WILLIAMS
Title or Position: CEO
Credential:
Phone: 850-288-7098