- Enrollment id
- O20051212000179
- Enrollment state
- FL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1023189321
- Multiple npi flag
- N
- Ccn
- 108063
- Associate id
- 8729009337
- Organization name
- E-MED SOURCE OF FLORIDA, INC.
- Doing business as name
- ANGELS CARE HOME HEALTH
- Incorporation date
- 2005-09-27
- Incorporation state
- TX
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 4801 GEORGE RD
- Address line 2
- STE 190
- City
- TAMPA
- State
- FL
- Zip code
- 336346200