Provider Demographics
NPI:1073172623
Name:ANGELS LIFE SKILLS CENTER, INC
Entity type:Organization
Organization Name:ANGELS LIFE SKILLS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:SAYRE
Authorized Official - Last Name:ODELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-717-4870
Mailing Address - Street 1:20829 KINGSLAND BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2713
Mailing Address - Country:US
Mailing Address - Phone:281-717-4870
Mailing Address - Fax:281-717-4920
Practice Address - Street 1:20829 KINGSLAND BLVD STE D
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2713
Practice Address - Country:US
Practice Address - Phone:281-717-4870
Practice Address - Fax:281-717-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities