Healthcare Provider Details

I. General information

NPI: 1407711195
Provider Name (Legal Business Name): ANGELS HOME HEALTH CARE GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 W WATERS AVE STE 202
TAMPA FL
33614-8153
US

IV. Provider business mailing address

4040 W WATERS AVE STE 202
TAMPA FL
33614-8153
US

V. Phone/Fax

Practice location:
  • Phone: 813-999-1020
  • Fax: 813-999-1156
Mailing address:
  • Phone: 813-999-1020
  • Fax: 813-999-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: YELENIS GRAVERAN OTANO
Title or Position: OWNER/CFO
Credential:
Phone: 813-531-4923