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General NPI Number Information
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NPI Number | 1124342852
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Entity Type | Organization
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Legal Business Name | ANGELS OF THE HEART
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 18870 CHURCH HILL DR
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City | RIVERVIEW
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State | MI
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Zip | 48193-1702
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Country | US
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Telephone | 734-589-2313
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Fax | 734-225-6495
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Provider Business Mailing Address
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Address Line | 17373 ROXBURY AVE
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City | SOUTHFIELD
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State | MI
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Zip | 48075-7610
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Country | US
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Telephone | 248-761-7452
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | STEPHEN IRA RANDALL
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Credential | CPA
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Telephone | 313-529-7002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AS80294958
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License Number State | MI
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