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General NPI Number Information
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NPI Number | 1750747093
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Entity Type | Organization
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Legal Business Name | ANGELO AND ANGELICKA ALLIANCE
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 508 BEACH 22ND ST PVT HOUSE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-2678
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Country | US
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Telephone | 347-268-5667
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Fax |
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Provider Business Mailing Address
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Address Line | 508 BEACH 22ND STREET PVT HOUSE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691
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Country | US
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Telephone | 347-268-5667
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Fax |
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Authorized Official
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Title or Position | SERVICES COORDINATOR SUPERVISOR
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Name | ANGELICKA S JAMES
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Credential |
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Telephone | 347-268-5667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | NY
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