Organization
ANGELS ON ASSIGNMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DERYLENE G. PROCTOR M.S. (OWNER)
(850) 544-3045
Entity
Organization
Contact information
Practice address
5773 N SALT RD, MONTICELLO, FL 32344-5173
(850) 544-3045
Mailing address
5773 N SALT RD, MONTICELLO, FL 32344-5173
(850) 544-3045
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
347C00000X
Private Vehicle
P623-167-59-760-0
FL
Other
Enumeration date
10/21/2015
Last updated
10/21/2015
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