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General NPI Number Information
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NPI Number | 1982331310
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Entity Type | Organization
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Legal Business Name | ANGELS LIGHT HALF WAY HOUSE LLC
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 201 DEPOT ST
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City | YOUNGWOOD
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State | PA
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Zip | 15697-1617
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Country | US
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Telephone | 724-635-3458
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Fax | 724-635-3463
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Provider Business Mailing Address
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Address Line | 201 DEPOT ST
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City | YOUNGWOOD
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State | PA
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Zip | 15697-1617
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Country | US
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Telephone | 724-635-3458
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Fax | 724-635-6463
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. KEITH GREENBERG
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Credential |
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Telephone | 914-907-1246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation 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 | 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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