- Enrollment id
- O20120404000983
- Enrollment state
- FL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1962433896
- Multiple npi flag
- N
- Ccn
- 107713
- Associate id
- 8123099074
- Organization name
- ANGEL HOME CARE SERVICES, INC.
- Incorporation state
- FL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 12955 SW 42ND ST
- Address line 2
- STE 104
- City
- MIAMI
- State
- FL
- Zip code
- 331752920