Organization
ANGEL GUARDIAN ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROSEANN J SIMONE (ADMINISTRATOR)
(321) 223-8371
Entity
Organization
Contact information
Practice address
280 BAHAMA DR, MERRITT ISLAND, FL 32952-3605
(321) 848-0255
Mailing address
280 BAHAMA DR., MERRITT ISLAND, FL 32952
(321) 848-0255
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL10561
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
PERSONAL SOCIAL SECURITY
NY
05
—
008458000
—
FL
01
—
1184967184
PERSONAL NPI #
FL
01
—
AL10561
AHCA LICENSE #
FL
Enumeration date
04/10/2014
Last updated
05/21/2020
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