Provider Demographics
NPI:1023332582
Name:ANGEL'S HOME
Entity type:Organization
Organization Name:ANGEL'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLACEMENT ADVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-882-3319
Mailing Address - Street 1:13772 W EARLL DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-3547
Mailing Address - Country:US
Mailing Address - Phone:623-214-7511
Mailing Address - Fax:
Practice Address - Street 1:13772 W EARLL DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-3547
Practice Address - Country:US
Practice Address - Phone:623-214-7511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3542323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility