Provider Demographics
NPI:1386248193
Name:SPECIAL ANGELS GROUP FACILITIES, INC
Entity type:Organization
Organization Name:SPECIAL ANGELS GROUP FACILITIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTARTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAZMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-543-7604
Mailing Address - Street 1:1053 N BRIERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3992
Mailing Address - Country:US
Mailing Address - Phone:909-543-7604
Mailing Address - Fax:909-961-2207
Practice Address - Street 1:1053 N BRIERWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-3992
Practice Address - Country:US
Practice Address - Phone:909-543-7604
Practice Address - Fax:909-961-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility