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General NPI Number Information
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NPI Number | 1588215578
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Entity Type | Organization
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Legal Business Name | ANGEL EYES HOME CARE LLC
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Dates
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Enumeration Date | 09/22/2019
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 1500 LAKELAND HILLS BLVD STE 2
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City | LAKELAND
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State | FL
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Zip | 33805-3257
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Country | US
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Telephone | 863-733-5336
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 971
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City | KATHLEEN
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State | FL
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Zip | 33849-0971
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Country | US
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Telephone | 863-733-5336
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. ALICIA CLAIRCIUS
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Credential | DNP, FNP-C
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Telephone | 638-944-6977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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