Provider Demographics
NPI:1578369906
Name:LITTLE ANGELS PEDIATRIC EXTENDED CARE LLC
Entity type:Organization
Organization Name:LITTLE ANGELS PEDIATRIC EXTENDED CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DANEIQUA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-403-5822
Mailing Address - Street 1:1400 W STATE ROAD 434 STE 1000
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3817
Mailing Address - Country:US
Mailing Address - Phone:407-403-5822
Mailing Address - Fax:
Practice Address - Street 1:1023 W ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-3482
Practice Address - Country:US
Practice Address - Phone:407-403-5822
Practice Address - Fax:407-403-5818
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUARDIAN ANGEL HOLDING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-25
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)