=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326330275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGEL LIFE CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2011
-----------------------------------------------------
Last Update Date | 05/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 560 ROYAL PALM BEACH BLVD
-----------------------------------------------------
City | ROYAL PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-7677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-383-6967
-----------------------------------------------------
Fax | 561-628-0256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 560 ROYAL PALM BEACH BLVD
-----------------------------------------------------
City | ROYAL PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-7677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-383-6967
-----------------------------------------------------
Fax | 561-628-0256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JON P ARNOLD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-360-0528
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------