MEDICARE: ANGEL GROUP HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1952804254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL GROUP HOME

Provider Business Mailing Address
First Line	:	90 MADISON ST STE 405
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-5413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 MADISON ST STE 405
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-5413
Country	:	US
Telephone Number	:	720-244-3035
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUNOU CHENG
Credential	:
Telephone Number	:	303-570-3053

Provider Enumeration Date	:	03/13/2018
Last Update Date	:	04/22/2019

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Directions to “ANGEL GROUP HOME ” Practice Location

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