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General NPI Number Information
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NPI Number | 1285778803
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Entity Type | Organization
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Legal Business Name | AMAZING ARC ANGELS INC.
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2005 DEWALT ST
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City | HOUSTON
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State | TX
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Zip | 77088-4719
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Country | US
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Telephone | 713-688-7731
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Fax | 713-688-7736
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Provider Business Mailing Address
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Address Line | 2005 DEWALT ST
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City | HOUSTON
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State | TX
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Zip | 77088-4719
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Country | US
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Telephone | 713-688-7731
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Fax | 713-688-7736
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Authorized Official
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Title or Position | CEO ADMINISTRATOR
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Name | MRS. KQISHA LENISE WORSHAM
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Credential |
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Telephone | 832-721-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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