Provider Demographics
NPI:1083014641
Name:JC ANGELS, LLC
Entity Type:Organization
Organization Name:JC ANGELS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:BENOJ
Authorized Official - Last Name:CHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-857-0589
Mailing Address - Street 1:2710 GREENBLADE CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3430
Mailing Address - Country:US
Mailing Address - Phone:713-857-0589
Mailing Address - Fax:
Practice Address - Street 1:2710 GREENBLADE CT
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3430
Practice Address - Country:US
Practice Address - Phone:713-857-0589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-01
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities