Provider Demographics
NPI:1316569338
Name:ANGELS RESIDENTIAL SERVICES, LLC
Entity Type:Organization
Organization Name:ANGELS RESIDENTIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MABINTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-861-8038
Mailing Address - Street 1:12770 RIPPLE CREEK CT APT 2314
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-6562
Mailing Address - Country:US
Mailing Address - Phone:703-861-8038
Mailing Address - Fax:
Practice Address - Street 1:12770 RIPPLE CREEK CT APT 2314
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6562
Practice Address - Country:US
Practice Address - Phone:703-861-8038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities