Provider Demographics
NPI:1720581101
Name:ARCH ANGEL SERVICES
Entity Type:Organization
Organization Name:ARCH ANGEL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTUAN
Authorized Official - Middle Name:DURALL
Authorized Official - Last Name:WILBON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:312-474-6189
Mailing Address - Street 1:10 S. RIVERSIDE PLAZA
Mailing Address - Street 2:SUITE 875
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606
Mailing Address - Country:US
Mailing Address - Phone:312-474-6189
Mailing Address - Fax:773-260-1479
Practice Address - Street 1:10 S. RIVERSIDE PLAZA
Practice Address - Street 2:SUITE 875
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606
Practice Address - Country:US
Practice Address - Phone:312-474-6189
Practice Address - Fax:773-260-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty