Provider Demographics
NPI:1609368307
Name:ANGELS LIGHT ADDICTION SPECIALISTS LLC
Entity Type:Organization
Organization Name:ANGELS LIGHT ADDICTION SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-217-2480
Mailing Address - Street 1:17201 COLLINS AVE APT 2505
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3482
Mailing Address - Country:US
Mailing Address - Phone:845-217-2480
Mailing Address - Fax:845-217-2481
Practice Address - Street 1:1023 PITTSBURGH RD STE 100
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8407
Practice Address - Country:US
Practice Address - Phone:724-550-4544
Practice Address - Fax:724-550-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness