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General NPI Number Information
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NPI Number | 1669803383
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Entity Type | Organization
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Legal Business Name | ANGEL HOUSE OF GEORGIA
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Dates
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Enumeration Date | 12/05/2013
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 838 MAPLE ST
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City | GAINESVILLE
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State | GA
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Zip | 30501-4436
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Country | US
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Telephone | 770-572-7945
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Fax | 888-480-2818
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Provider Business Mailing Address
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Address Line | 4625 BEACON RIDGE LN
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-3447
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Country | US
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Telephone | 770-572-7945
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Fax | 888-480-2818
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. ANGELA ENGLISH
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Credential |
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Telephone | 770-572-7945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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