Provider Demographics
NPI:1346015427
Name:ANGELIC ADVANCE SUPPORT COORDINATOR
Entity Type:Organization
Organization Name:ANGELIC ADVANCE SUPPORT COORDINATOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEEMA
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MUSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-300-0095
Mailing Address - Street 1:1107 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:EFFORT
Mailing Address - State:PA
Mailing Address - Zip Code:18330-2301
Mailing Address - Country:US
Mailing Address - Phone:319-464-1188
Mailing Address - Fax:
Practice Address - Street 1:399 2ND ST APT 3R
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2248
Practice Address - Country:US
Practice Address - Phone:319-300-0095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No305S00000XManaged Care OrganizationsPoint of Service