Provider Demographics
NPI:1205223054
Name:ANGELS FOR KIDS
Entity Type:Organization
Organization Name:ANGELS FOR KIDS
Other - Org Name:BEAHVIORAL SUPPORT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PSR/TCM
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:E
Authorized Official - Last Name:GROSSO ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:786-382-9045
Mailing Address - Street 1:1020 HONEY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-4866
Mailing Address - Country:US
Mailing Address - Phone:786-382-9045
Mailing Address - Fax:
Practice Address - Street 1:1020 HONEY BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4866
Practice Address - Country:US
Practice Address - Phone:786-382-9045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health