Healthcare Provider Details

I. General information

NPI: 1144951708
Provider Name (Legal Business Name): ANGELS OF LIGHT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 NATURE VIEW RD
SAINT CLOUD FL
34771-9330
US

IV. Provider business mailing address

2704 NATURE VIEW RD
SAINT CLOUD FL
34771-9330
US

V. Phone/Fax

Practice location:
  • Phone: 407-416-5457
  • Fax:
Mailing address:
  • Phone: 407-416-5457
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE RODRIGUEZ
Title or Position: MANAGER/OWNER
Credential:
Phone: 407-416-5457