Provider Demographics
NPI:1316518939
Name:ANGELS FOR KIDS ON CALL 24/7 INC.
Entity type:Organization
Organization Name:ANGELS FOR KIDS ON CALL 24/7 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-730-7983
Mailing Address - Street 1:1071 PORT MALABAR BLVD NE STE 106
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-5161
Mailing Address - Country:US
Mailing Address - Phone:407-730-7983
Mailing Address - Fax:
Practice Address - Street 1:1071 PORT MALABAR BLVD NE STE 106
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5161
Practice Address - Country:US
Practice Address - Phone:407-730-7983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELS FOR KIDS ON CALL 24/7 INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012380400Medicaid