Provider Demographics
NPI:1871384180
Name:ANGEL COMMUNITY ALLIANCE, INC
Entity type:Organization
Organization Name:ANGEL COMMUNITY ALLIANCE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-426-9677
Mailing Address - Street 1:508 BEACH 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2678
Mailing Address - Country:US
Mailing Address - Phone:929-427-9677
Mailing Address - Fax:516-268-9322
Practice Address - Street 1:508 BEACH 22ND ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2678
Practice Address - Country:US
Practice Address - Phone:929-427-9677
Practice Address - Fax:516-268-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-15
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management