Provider Demographics
NPI:1245715283
Name:FAVORED ANGELS INC
Entity type:Organization
Organization Name:FAVORED ANGELS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OLAJUMOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:443-474-1757
Mailing Address - Street 1:1632 MORNING GLORY LN
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-1601
Mailing Address - Country:US
Mailing Address - Phone:443-474-1757
Mailing Address - Fax:
Practice Address - Street 1:1632 MORNING GLORY LN
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-1601
Practice Address - Country:US
Practice Address - Phone:443-474-1757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities