Provider Demographics
NPI:1346594405
Name:ANGIE WELLNESS & RECOVERY CENTER
Entity Type:Organization
Organization Name:ANGIE WELLNESS & RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORY
Authorized Official - Middle Name:BASSEY
Authorized Official - Last Name:EDUKERE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:909-418-8289
Mailing Address - Street 1:637 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-3669
Mailing Address - Country:US
Mailing Address - Phone:909-418-8289
Mailing Address - Fax:
Practice Address - Street 1:637 N PARK AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3669
Practice Address - Country:US
Practice Address - Phone:909-418-8289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-28
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health