MEDICARE: ANGELS ADULT DAY CARE INC

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	261QD1600X	Developmental Disabilities Clinic/Center
2	261QA0600X	Adult Day Care Clinic/Center	9205	FL

General Provider Information

NPI Number	:	1215282884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS ADULT DAY CARE INC

Provider Business Mailing Address
First Line	:	2350 W 84TH ST
Second Line	:	BAY 19
City	:	HIALEAH
State	:	FL
Zip	:	33016-5575
Country	:	US
Telephone Number	:	786-343-7772
Fax Number	:	305-454-4861

Provider Business Practice Location Address
First Line	:	2350 W 84TH ST STE 19
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1857
Country	:	US
Telephone Number	:	786-343-7772
Fax Number	:	305-771-7550

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SORANGEL GUTIERREZ
Credential	:
Telephone Number	:	786-343-7772

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	12/22/2022

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