Provider Demographics
NPI:1942624606
Name:ANGELA MCMAHON
Entity Type:Organization
Organization Name:ANGELA MCMAHON
Other - Org Name:DEVELOPMENT AND RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:IMF, EDD (C)
Authorized Official - Phone:619-871-7345
Mailing Address - Street 1:1043 S SUNSHINE AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020
Mailing Address - Country:US
Mailing Address - Phone:619-871-7345
Mailing Address - Fax:
Practice Address - Street 1:1043 S SUNSHINE AVE APT 14
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020
Practice Address - Country:US
Practice Address - Phone:619-871-7345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility