Healthcare Provider Details

I. General information

NPI: 1669771572
Provider Name (Legal Business Name): ANGELS GARDEN ACLF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 N ROME AVE
TAMPA FL
33604-3820
US

IV. Provider business mailing address

8003 N ROME AVE
TAMPA FL
33604-3820
US

V. Phone/Fax

Practice location:
  • Phone: 813-933-4585
  • Fax: 813-933-3785
Mailing address:
  • Phone: 813-933-4585
  • Fax: 813-933-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: MRS. DELIA VALDES-DIAZ
Title or Position: ADMINISTRATOR
Credential: VICE PRESIDENT
Phone: 813-933-4585