MEDICARE: CLARA'S ANGELS

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	251J00000X	Nursing Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1659911790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARA'S ANGELS

Provider Business Mailing Address
First Line	:	425 BRECKENRIDGE CIR SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-2341
Country	:	US
Telephone Number	:	321-215-8304
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 BRECKENRIDGE CIR SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-2341
Country	:	US
Telephone Number	:	321-215-8304
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MILTIYIA BLAIN
Credential	:
Telephone Number	:	321-215-8304

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	01/07/2020

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