Organization
DIVINE ANGELS SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINICA CAMPOS (PRESIDENT)
(786) 316-5224
Entity
Organization
Contact information
Practice address
10300 SW 72ND STREET, SUITE 460-7, MIAMI, FL 33173-1828
(786) 316-5224
(305) 275-1828
Mailing address
10300 SW 72ND STREET, SUITE 460-7, MIAMI, FL 33173-1828
(786) 316-5224
(305) 392-1828
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
230135
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000287900
DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY-BASED WAIVER SERVICES
FL
05
—
000287901
—
FL
Enumeration date
10/16/2013
Last updated
07/28/2015
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