MEDICARE: ANGELS IN PARADISE

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	3104A0625X	Assisted Living Facility (Mental Illness)	AL10296	FL

General Provider Information

NPI Number	:	1194986059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS IN PARADISE

Provider Business Mailing Address
First Line	:	4636 W 6TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3802
Country	:	US
Telephone Number	:	305-818-9666
Fax Number	:	305-818-9666

Provider Business Practice Location Address
First Line	:	4636 W 6TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3802
Country	:	US
Telephone Number	:	305-818-9666
Fax Number	:	305-818-9666

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MAGALY B TRES
Credential	:
Telephone Number	:	305-818-9666

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/23/2008

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Directions to “ANGELS IN PARADISE ” Practice Location

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