Provider Demographics
NPI:1174009021
Name:ANGELCARE WITH A VISION
Entity type:Organization
Organization Name:ANGELCARE WITH A VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CEASOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-273-3703
Mailing Address - Street 1:3577 FLAT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324
Mailing Address - Country:US
Mailing Address - Phone:850-442-4213
Mailing Address - Fax:
Practice Address - Street 1:3577 FLAT CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324
Practice Address - Country:US
Practice Address - Phone:850-442-4213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA0600X, 372600000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty