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General NPI Number Information
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NPI Number | 1386035533
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Entity Type | Organization
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Legal Business Name | ANGELS TCH, LLC
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 3115 S MILLER RD
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City | VALRICO
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State | FL
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Zip | 33596-5716
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Country | US
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Telephone | 813-412-6560
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Fax | 831-850-6633
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Provider Business Mailing Address
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Address Line | 11207 COCOA BEACH DR
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City | RIVERVIEW
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State | FL
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Zip | 33569-2949
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Country | US
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Telephone | 813-412-6560
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Fax | 831-850-6633
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. CLIFTON RAY SCOTT
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Credential |
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Telephone | 813-412-6560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12347
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License Number State | FL
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