Healthcare Provider Details

I. General information

NPI: 1295489839
Provider Name (Legal Business Name): ANGELCARE ABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BROAD ST STE 1930
PHILADELPHIA PA
19110-1025
US

IV. Provider business mailing address

146 E KING ST STE 1120
LANCASTER PA
17602-2832
US

V. Phone/Fax

Practice location:
  • Phone: 302-990-2323
  • Fax: 844-440-2323
Mailing address:
  • Phone: 302-990-2323
  • Fax: 844-440-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: BLIMA BREZEL
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 302-990-2323