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General NPI Number Information
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NPI Number | 1669871166
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Entity Type | Organization
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Legal Business Name | ANGEL HEART SUPPORT SERVICES, INC
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 18901 SW 106TH AVE A111
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City | CUTLER BAY
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State | FL
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Zip | 33157-7661
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Country | US
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Telephone | 305-232-5330
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Fax | 305-359-9221
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Provider Business Mailing Address
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Address Line | 18901 SW 106TH AVE A111
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City | CUTLER BAY
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State | FL
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Zip | 33157-7661
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Country | US
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Telephone | 305-232-5330
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Fax | 305-359-9221
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Authorized Official
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Title or Position | DIRECTOR
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Name | EARTHA MAYS
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Credential |
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Telephone | 305-232-5330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 6888305901
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 688830501
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License Number State | FL
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