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General NPI Number Information
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NPI Number | 1184349185
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Entity Type | Organization
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Legal Business Name | EARTH ANGELS HEALTH & WELLNESS, LLC
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 10177 LANCASHIRE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32219-4367
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Country | US
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Telephone | 904-729-5242
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Fax | 904-765-3155
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Provider Business Mailing Address
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Address Line | PO BOX 28585
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City | JACKSONVILLE
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State | FL
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Zip | 32226-8585
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Country | US
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Telephone | 904-729-5242
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Fax | 904-765-3155
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Authorized Official
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Title or Position | OWNER/CEO
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Name | LEGA K LONG
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Credential | MS
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Telephone | 904-729-5242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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