Organization
ANGELS SENIOR LIVING AT THE LODGES OF IDLEWILD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT BENNETT (OFFICER)
(813) 886-2023
Entity
Organization
Contact information
Practice address
18440 EXCITING IDLEWILD BLVD, LUTZ, FL 33548-4573
(813) 264-8200
Mailing address
18440 EXCITING IDLEWILD BLVD, LUTZ, FL 33548-4573
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
12899
FL
Other
Enumeration date
11/01/2016
Last updated
11/01/2016
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