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General NPI Number Information
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NPI Number | 1619463007
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Entity Type | Organization
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Legal Business Name | ANGEL'S SENIOR LIVING II, LLC
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 5855 BOGGS FORD RD
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City | PORT ORANGE
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State | FL
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Zip | 32127-5870
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Country | US
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Telephone | 386-527-5918
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Fax |
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Provider Business Mailing Address
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Address Line | 5855 BOGGS FORD RD
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City | PORT ORANGE
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State | FL
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Zip | 32127-5870
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Country | US
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Telephone | 386-527-5918
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. TINA MARIE CARLYLE
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Credential |
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Telephone | 386-527-5918
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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 | ALF13130
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License Number State | FL
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