MEDICARE: ANGELS OF LIGHT HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QD1600X	Developmental Disabilities Clinic/Center
3	251E00000X	Home Health Agency

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

General Provider Information

NPI Number	:	1144951708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS OF LIGHT HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	2704 NATURE VIEW RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-9330
Country	:	US
Telephone Number	:	407-416-5457
Fax Number	:

Provider Business Practice Location Address
First Line	:	2704 NATURE VIEW RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-9330
Country	:	US
Telephone Number	:	407-416-5457
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/OWNER
Name	:	KATHERINE RODRIGUEZ
Credential	:
Telephone Number	:	407-416-5457

Provider Enumeration Date	:	06/23/2022
Last Update Date	:	06/23/2022

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