Healthcare Provider Details

I. General information

NPI: 1700597440
Provider Name (Legal Business Name): ANGELES ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13013 W LINEBAUGH AVE STE B
TAMPA FL
33626-4451
US

IV. Provider business mailing address

13013 W LINEBAUGH AVE STE B
TAMPA FL
33626-4451
US

V. Phone/Fax

Practice location:
  • Phone: 813-606-0272
  • Fax:
Mailing address:
  • Phone: 813-606-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE FLEITES
Title or Position: OWNER
Credential:
Phone: 813-606-0272