Provider Demographics
NPI:1538729355
Name:DIVINE ANGEL ADULT DAY CARE INC
Entity type:Organization
Organization Name:DIVINE ANGEL ADULT DAY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YAMIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-467-2353
Mailing Address - Street 1:1626 NE 17TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-5603
Mailing Address - Country:US
Mailing Address - Phone:941-467-2353
Mailing Address - Fax:
Practice Address - Street 1:3443 HANCOCK BRIDGE PKWY STE 501
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7007
Practice Address - Country:US
Practice Address - Phone:941-467-2353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care