Provider Demographics
NPI:1215231493
Name:ANGEL'S NEST, INC.
Entity Type:Organization
Organization Name:ANGEL'S NEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW, CAAC
Authorized Official - Phone:313-529-1687
Mailing Address - Street 1:17340 W 12 MILE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2122
Mailing Address - Country:US
Mailing Address - Phone:313-529-1687
Mailing Address - Fax:888-391-7092
Practice Address - Street 1:17340 W 12 MILE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2122
Practice Address - Country:US
Practice Address - Phone:313-529-1687
Practice Address - Fax:888-391-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801046795251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management