Healthcare Provider Details

I. General information

NPI: 1710870142
Provider Name (Legal Business Name): ARCHANGEL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 W MAPLEWOOD AVE
DAYTON OH
45405-2813
US

IV. Provider business mailing address

26 W MAPLEWOOD AVE
DAYTON OH
45405-2813
US

V. Phone/Fax

Practice location:
  • Phone: 937-219-8866
  • Fax:
Mailing address:
  • Phone: 937-219-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DEVIN SCOTT
Title or Position: OWNER
Credential:
Phone: 937-219-8866