MEDICARE: NURSING CARE BY ANGELS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL12241	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033462197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSING CARE BY ANGELS

Provider Business Mailing Address
First Line	:	8085 BABCOCK ST SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-5910
Country	:	US
Telephone Number	:	321-345-4774
Fax Number	:	321-914-0712

Provider Business Practice Location Address
First Line	:	8085 BABCOCK ST SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-5910
Country	:	US
Telephone Number	:	321-345-4774
Fax Number	:	321-914-0712

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CORALIE PRINCE
Credential	:	RN
Telephone Number	:	321-299-7687

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	10/25/2012

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