Healthcare Provider Details

I. General information

NPI: 1932918174
Provider Name (Legal Business Name): HEAVENLY ANGELS COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 W AVENUE K4
LANCASTER CA
93536-6616
US

IV. Provider business mailing address

417 WRENWOOD DR
CLAYTON NC
27527-3398
US

V. Phone/Fax

Practice location:
  • Phone: 661-265-5031
  • Fax: 866-574-4417
Mailing address:
  • Phone: 661-265-5031
  • Fax: 866-574-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LELA RENEE LEMELL
Title or Position: CEO/PRESIDENT
Credential:
Phone: 661-265-5031