MEDICARE: ANGELS WITH HEARTS 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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1568952372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS WITH HEARTS LLC

Provider Business Mailing Address
First Line	:	1660 40TH ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3640
Country	:	US
Telephone Number	:	561-614-7513
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 40TH ST
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3640
Country	:	US
Telephone Number	:	561-614-7513
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHANIE LATRINA HOLLAND
Credential	:
Telephone Number	:	561-614-7513

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	05/16/2018

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Directions to “ANGELS WITH HEARTS LLC ” Practice Location

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