Provider Demographics
NPI:1750747093
Name:ANGELO AND ANGELICKA ALLIANCE
Entity type:Organization
Organization Name:ANGELO AND ANGELICKA ALLIANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SERVICES COORDINATOR SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-268-5667
Mailing Address - Street 1:508 BEACH 22ND STREET
Mailing Address - Street 2:PVT HOUSE
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:347-268-5667
Mailing Address - Fax:
Practice Address - Street 1:508 BEACH 22ND ST
Practice Address - Street 2:PVT HOUSE
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2678
Practice Address - Country:US
Practice Address - Phone:347-268-5667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management