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General NPI Number Information
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NPI Number | 1508581646
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Entity Type | Organization
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Legal Business Name | COMPANION ANGEL'S PROFESSIONAL LIMITED LIABILITY COMPANY
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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 | 157 NORMA DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-6509
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Country | US
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Telephone | 352-682-7537
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Fax |
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Provider Business Mailing Address
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Address Line | 157 NORMA DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-6509
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Country | US
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Telephone | 352-682-7537
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Fax |
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Authorized Official
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Title or Position | CERTIFIED NURSE ASSISTANT
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Name | ANGEL A GREEN
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Credential |
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Telephone | 352-682-7537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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