Healthcare Provider Details

I. General information

NPI: 1174695142
Provider Name (Legal Business Name): ANGELS OUTREACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 MARTI LN STE 5B
MONTGOMERY AL
36116-3115
US

IV. Provider business mailing address

2921 MARTI LN STE 5B
MONTGOMERY AL
36116-3115
US

V. Phone/Fax

Practice location:
  • Phone: 334-356-3597
  • Fax: 334-356-3991
Mailing address:
  • Phone: 334-356-3597
  • Fax: 334-356-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBRA T SMITH-MATFIELD
Title or Position: OWNER
Credential:
Phone: 334-356-3597