Provider Demographics
NPI:1104466788
Name:ANGEL'S LEGACY, LLC
Entity type:Organization
Organization Name:ANGEL'S LEGACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:REY
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-310-1707
Mailing Address - Street 1:777 N ORANGE AVE APT 716
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1188
Mailing Address - Country:US
Mailing Address - Phone:407-310-1707
Mailing Address - Fax:877-538-5599
Practice Address - Street 1:777 N ORANGE AVE APT 716
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1188
Practice Address - Country:US
Practice Address - Phone:407-310-1707
Practice Address - Fax:877-538-5599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGEL'S LEGACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-10
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Multi-Specialty
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service