Provider Demographics
NPI:1245568591
Name:ANGEL CARE SERVICES LLC
Entity Type:Organization
Organization Name:ANGEL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-863-8224
Mailing Address - Street 1:20206 ROGGE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3090
Mailing Address - Country:US
Mailing Address - Phone:313-863-8224
Mailing Address - Fax:313-533-0967
Practice Address - Street 1:20206 ROGGE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3090
Practice Address - Country:US
Practice Address - Phone:313-863-8224
Practice Address - Fax:313-533-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010334751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty