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General NPI Number Information
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NPI Number | 1861100646
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Entity Type | Organization
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Legal Business Name | UNDER ANGEL'S WINGS RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 5411 2ND AVE FL 1
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City | BROOKLYN
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State | NY
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Zip | 11220-2664
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Country | US
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Telephone | 718-374-5484
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Fax |
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Provider Business Mailing Address
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Address Line | 1588 E 58TH ST
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City | BROOKLYN
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State | NY
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Zip | 11234-4102
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Country | US
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Telephone | 917-620-0105
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Fax |
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Authorized Official
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Title or Position | BILLING COORDINATOR
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Name | MR. VLADIMIR DELBRUNE
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Credential | MBA
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Telephone | 917-362-4332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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