Organization
DOROTHY'S ANGELS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CRYSTAL TRAMAINE SIMMONS LPN (OWNER)
(904) 894-8386
Entity
Organization
Contact information
Practice address
3190 SEDONA TRL, JACKSONVILLE, FL 32208
(904) 798-0282
Mailing address
3190 SEDONA TRL, JACKSONVILLE, FL 32208-8441
(904) 798-0282
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
—
—
251J00000X
Nursing Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
372600000X
Adult Companion
—
—
376J00000X
Homemaker
—
—
376K00000X
Nurse's Aide
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
05/08/2018
Last updated
08/27/2018
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