Provider Demographics
NPI:1992565220
Name:HARRIS NOURISHING ANGELS LLC
Entity type:Organization
Organization Name:HARRIS NOURISHING ANGELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:727-642-6922
Mailing Address - Street 1:2314 30TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-3340
Mailing Address - Country:US
Mailing Address - Phone:727-642-6922
Mailing Address - Fax:
Practice Address - Street 1:2314 30TH ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-3340
Practice Address - Country:US
Practice Address - Phone:727-642-6922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120170300Medicaid
FL239939OtherAGENCY FOR HEALTHCARE ADMINISTRATION