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General NPI Number Information
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NPI Number | 1457642241
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Entity Type | Organization
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Legal Business Name | ANGEL PEDIATRIC HEALTH CARE FACILITY INC.
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 2589 N STATE ROAD 7
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-2778
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Country | US
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Telephone | 954-322-0752
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Fax |
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Provider Business Mailing Address
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Address Line | 2589 N STATE ROAD 7
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-2778
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MYRA A. WEISS BOGACZ
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Credential | R.N.
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Telephone | 954-332-0752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 60080978
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License Number State | FL
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