Provider Demographics
NPI:1871860452
Name:ARCHANGEL ADULT DAYCARE SERVICES, LLC
Entity Type:Organization
Organization Name:ARCHANGEL ADULT DAYCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GRAY-PAUL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOSSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-840-6125
Mailing Address - Street 1:1214 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2902
Mailing Address - Country:US
Mailing Address - Phone:570-909-9672
Mailing Address - Fax:570-909-9738
Practice Address - Street 1:1214 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18510-2902
Practice Address - Country:US
Practice Address - Phone:570-909-9672
Practice Address - Fax:570-909-9738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-26
Last Update Date:2011-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA384924261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care