Provider Demographics
NPI:1104475763
Name:ANGEL FAMILY CARE, LLC
Entity type:Organization
Organization Name:ANGEL FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANTELLE
Authorized Official - Middle Name:EZINNE
Authorized Official - Last Name:OGUADIMMA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:480-720-3393
Mailing Address - Street 1:28370 N GOLD LN
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-6059
Mailing Address - Country:US
Mailing Address - Phone:480-720-3393
Mailing Address - Fax:
Practice Address - Street 1:28370 N GOLD LN
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-6059
Practice Address - Country:US
Practice Address - Phone:480-720-3393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health