=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700497740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGEL'S TOUCH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2020
-----------------------------------------------------
Last Update Date | 08/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11216 MCMULLEN RD
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33569-6310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-416-6810
-----------------------------------------------------
Fax | 831-850-6633
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11207 COCOA BEACH DR
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33569-2949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-412-6560
-----------------------------------------------------
Fax | 831-850-6633
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | CLIFTON SCOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-412-6560
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------