Healthcare Provider Details

I. General information

NPI: 1811227770
Provider Name (Legal Business Name): ANGELS ON HIGH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 HIGH ST
SOUTH PORTLAND ME
04106-1514
US

IV. Provider business mailing address

171 OCEAN STREET SUITE 100
SOUTH PORTLAND ME
04106
US

V. Phone/Fax

Practice location:
  • Phone: 207-767-5820
  • Fax: 207-799-5225
Mailing address:
  • Phone: 207-767-5820
  • Fax: 207-799-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGEL M. HAMILTON
Title or Position: PRESIDENT
Credential:
Phone: 207-767-5820