Provider Demographics
NPI:1457000507
Name:ANGELS HARBOR
Entity Type:Organization
Organization Name:ANGELS HARBOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-993-0399
Mailing Address - Street 1:4945 STATE ROUTE 339
Mailing Address - Street 2:
Mailing Address - City:VINCENT
Mailing Address - State:OH
Mailing Address - Zip Code:45784-5106
Mailing Address - Country:US
Mailing Address - Phone:740-538-2956
Mailing Address - Fax:
Practice Address - Street 1:4945 STATE ROUTE 339
Practice Address - Street 2:
Practice Address - City:VINCENT
Practice Address - State:OH
Practice Address - Zip Code:45784-5106
Practice Address - Country:US
Practice Address - Phone:740-538-2956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility