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General NPI Number Information
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NPI Number | 1245568591
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Entity Type | Organization
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Legal Business Name | ANGEL CARE SERVICES LLC
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 20206 ROGGE ST
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City | DETROIT
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State | MI
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Zip | 48234-3090
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Country | US
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Telephone | 313-863-8224
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Fax | 313-533-0967
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Provider Business Mailing Address
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Address Line | 20206 ROGGE ST
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City | DETROIT
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State | MI
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Zip | 48234-3090
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Country | US
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Telephone | 313-863-8224
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Fax | 313-533-0967
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Authorized Official
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Title or Position | COO
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Name | MR. MATTHEW D JONES JR.
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Credential | LMSW
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Telephone | 313-863-8224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801033475
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License Number State | MI
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