Provider Demographics
NPI:1649446238
Name:ANGEL ADAMS INC
Entity type:Organization
Organization Name:ANGEL ADAMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:414-445-9797
Mailing Address - Street 1:6040 W LISBON AVE
Mailing Address - Street 2:SUITE B2
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2116
Mailing Address - Country:US
Mailing Address - Phone:414-445-9797
Mailing Address - Fax:414-445-7979
Practice Address - Street 1:6040 W LISBON AVE
Practice Address - Street 2:SUITE B2
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2116
Practice Address - Country:US
Practice Address - Phone:414-445-9797
Practice Address - Fax:414-445-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2703251V00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable