Provider Demographics
NPI:1346634714
Name:ANGEL HOPE HOUSE
Entity Type:Organization
Organization Name:ANGEL HOPE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAKA
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC, LAC
Authorized Official - Phone:973-373-6800
Mailing Address - Street 1:800 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-1004
Mailing Address - Country:US
Mailing Address - Phone:973-373-6800
Mailing Address - Fax:973-373-6802
Practice Address - Street 1:800 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-1004
Practice Address - Country:US
Practice Address - Phone:973-373-6800
Practice Address - Fax:973-373-6802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1000125324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility