Provider Demographics
NPI:1093453615
Name:ARCH ANGEL SERVICES
Entity Type:Organization
Organization Name:ARCH ANGEL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTUAN
Authorized Official - Middle Name:DURALL
Authorized Official - Last Name:WILBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-743-2608
Mailing Address - Street 1:20 S 3RD ST STE 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4206
Mailing Address - Country:US
Mailing Address - Phone:833-427-2264
Mailing Address - Fax:773-260-1479
Practice Address - Street 1:4182 WORTH AVE STE 1-115
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1535
Practice Address - Country:US
Practice Address - Phone:312-474-6189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL17014Medicaid