Provider Demographics
NPI:1750014726
Name:FAITH GROUP ANGELS, LLC
Entity type:Organization
Organization Name:FAITH GROUP ANGELS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UREJO
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:HAJI BARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-218-8074
Mailing Address - Street 1:5308 W NOVAK WAY
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339
Mailing Address - Country:US
Mailing Address - Phone:623-218-8074
Mailing Address - Fax:
Practice Address - Street 1:5308 W NOVAK WAY
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339
Practice Address - Country:US
Practice Address - Phone:623-218-8074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1922739663OtherBEHAVIORAL HEALTH RESIDENTIAL FACILITY OPERATOR