Provider Demographics
NPI:1598902090
Name:ANGELS QUALITY CARE 11, INC.
Entity Type:Organization
Organization Name:ANGELS QUALITY CARE 11, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-498-7069
Mailing Address - Street 1:PO BOX 382089
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75138-2026
Mailing Address - Country:US
Mailing Address - Phone:214-498-7069
Mailing Address - Fax:972-296-0979
Practice Address - Street 1:831 MIDDLE RUN CT
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2026
Practice Address - Country:US
Practice Address - Phone:214-498-7069
Practice Address - Fax:972-296-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities