Provider Demographics
NPI:1992157465
Name:ANGELS WITH A DIVINE PURPOSE
Entity type:Organization
Organization Name:ANGELS WITH A DIVINE PURPOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:ALF/NHA
Authorized Official - Phone:850-510-3080
Mailing Address - Street 1:240 SE STEPHENS AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-2656
Mailing Address - Country:US
Mailing Address - Phone:850-510-3080
Mailing Address - Fax:850-973-2066
Practice Address - Street 1:240 SE STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2656
Practice Address - Country:US
Practice Address - Phone:850-510-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness