=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174009021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELCARE WITH A VISION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2018
-----------------------------------------------------
Last Update Date | 07/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3577 FLAT CREEK RD
-----------------------------------------------------
City | CHATTAHOOCHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-442-4213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3577 FLAT CREEK RD
-----------------------------------------------------
City | CHATTAHOOCHEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-442-4213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. TAMMY L CEASOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-273-3703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------