Angel's Inn

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

330F036 Issued in NY

Legal business name

ANGEL'S INN

Practice address

518 Pine St
Watertown, NY 13601-3235

Phone

(315) 782-2238

NPI assigned

Feb 26, 2016

Last updated

Feb 26, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Floyd Austin Bradley, LHNA

Title

Administrator

Phone

(315) 782-2238

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456444800000",
    "number": "1467812941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 PINE ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136013235",
            "telephone_number": "315-782-2238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 PINE ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136013235",
            "telephone_number": "315-782-2238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL'S INN",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-26",
        "last_updated": "2016-02-26",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "FLOYD",
        "authorized_official_middle_name": "AUSTIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "315-782-2238",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LHNA"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NY",
            "license": "330F036",
            "primary": true
        },
        {
            "code": "376G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nursing Home Administrator",
            "state": "NY",
            "license": "05684",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Lynne Amelio, LPN, CRMT
• Lynn Ann Amell, OTR/L
• Andrea E Amyot
• Jennifer Leanne Anderson
• Jennifer Lee Andrews, DPT
• Dawn M Angello, LPN
• David H Antecol, MD
• Aqua Dental PC
• John Arber, MD
• Lilia Arellano, PRS/PSR

• Adult Care Home Facility in Watertown, NY
• Providers in Watertown, NY by specialty
• Adult Care Home Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.