MEDICARE: ANGELS PURE LIFE BA LLC

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1205767969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS PURE LIFE BA LLC

Provider Business Mailing Address
First Line	:	1518 SW 52ND TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-7484
Country	:	US
Telephone Number	:	786-988-0746
Fax Number	:

Provider Business Practice Location Address
First Line	:	1518 SW 52ND TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-7484
Country	:	US
Telephone Number	:	786-988-0746
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BARBARA VALDES
Credential	:
Telephone Number	:	786-988-0746

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ANGELS PURE LIFE BA LLC ” Practice Location

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