| Angels For Kids On Call 24/7 Inc. | |
|
1071 Port Malabar Blvd Ne Ste 106 Palm Bay FL 32905-5161 | |
| (321) 373-8801 | |
| (407) 985-3678 |
| Full Name | Angels For Kids On Call 24/7 Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1071 Port Malabar Blvd Ne Ste 106, Palm Bay, Florida |
| Authorized Official Name and Position | John Valencia (BILLING) |
| Authorized Official Contact | 4077307983 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Angels For Kids On Call 24/7 Inc. 1071 Port Malabar Blvd Ne Ste 106 Palm Bay FL 32905-5161 Ph: (407) 730-7983 | Angels For Kids On Call 24/7 Inc. 1071 Port Malabar Blvd Ne Ste 106 Palm Bay FL 32905-5161 Ph: (321) 373-8801 |
| NPI Number | 1629483706 |
|---|---|
| Provider Enumeration Date | 06/26/2014 |
| Last Update Date | 01/18/2023 |
| Certification Date | 01/18/2023 |
| Medicare PECOS PAC ID | 0941639488 |
|---|---|
| Medicare Enrollment ID | O20220202001012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629483706 | NPI | - | NPPES |
| 012331300 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Florida) | Primary |
| Provider Name | Orlando E Silva |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1689681868 PECOS PAC ID: 1456548940 Enrollment ID: I20101209000781 |
| Provider Name | Virmarie Diaz Fernandez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306248075 PECOS PAC ID: 8628499506 Enrollment ID: I20200601002191 |
| Provider Name | Roger Granjean |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437377785 PECOS PAC ID: 3072906635 Enrollment ID: I20220203001989 |
| Provider Name | Jessica Matos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306479399 PECOS PAC ID: 2668866831 Enrollment ID: I20220303002649 |
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