Healthcare Provider Details

I. General information

NPI: 1457897571
Provider Name (Legal Business Name): ANGELS FAMILY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 W CUSTER PL
DENVER CO
80219-2297
US

IV. Provider business mailing address

5155 W CUSTER PL
DENVER CO
80219-2297
US

V. Phone/Fax

Practice location:
  • Phone: 303-642-5502
  • Fax: 303-935-7319
Mailing address:
  • Phone: 303-642-5502
  • Fax: 303-935-7319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. CONSTANTINO CRUZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-642-5502