Provider Demographics
NPI:1982331310
Name:ANGELS LIGHT HALF WAY HOUSE LLC
Entity Type:Organization
Organization Name:ANGELS LIGHT HALF WAY HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-907-1246
Mailing Address - Street 1:201 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15697-1617
Mailing Address - Country:US
Mailing Address - Phone:724-635-3458
Mailing Address - Fax:724-635-6463
Practice Address - Street 1:201 DEPOT ST
Practice Address - Street 2:
Practice Address - City:YOUNGWOOD
Practice Address - State:PA
Practice Address - Zip Code:15697-1617
Practice Address - Country:US
Practice Address - Phone:724-635-3458
Practice Address - Fax:724-635-3463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation