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General NPI Number Information
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NPI Number | 1356620017
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Entity Type | Organization
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Legal Business Name | ANGELS FAMILY LLC
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Dates
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Enumeration Date | 08/12/2011
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Last Update Date | 08/12/2011
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Provider Practice Location Address
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Address Line | 5155 W CUSTER PL
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City | DENVER
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State | CO
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Zip | 80219-2297
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Country | US
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Telephone | 303-642-5502
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Fax |
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Provider Business Mailing Address
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Address Line | 5155 W CUSTER PL
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City | DENVER
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State | CO
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Zip | 80219-2297
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Country | US
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Telephone | 303-642-5502
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CONSTANTINO CRUZ
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Credential |
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Telephone | 303-642-5502
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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 | 20111421085
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License Number State | CO
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