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General NPI Number Information
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NPI Number | 1376695965
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Entity Type | Organization
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Legal Business Name | ANGELS UNAWARE INC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 4918 W LINEBAUGH AVENUE
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City | TAMPA
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State | FL
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Zip | 33624-5028
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Country | US
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Telephone | 813-961-1159
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Fax | 813-265-1656
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Provider Business Mailing Address
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Address Line | PO BOX 270040
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City | TAMPA
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State | FL
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Zip | 33688-0040
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Country | US
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Telephone | 813-961-1159
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Fax | 813-265-1656
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ROSS HOLTEN OBANION JR.
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Credential |
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Telephone | 813-961-1159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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