Provider Demographics
NPI:1427789346
Name:MOTHER OF AN ANGEL LLC
Entity type:Organization
Organization Name:MOTHER OF AN ANGEL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:APRIL
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-202-2578
Mailing Address - Street 1:261 KAWAMEEH DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-8314
Mailing Address - Country:US
Mailing Address - Phone:862-202-2578
Mailing Address - Fax:
Practice Address - Street 1:2525 ROUTE 130 BLDG C
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3513
Practice Address - Country:US
Practice Address - Phone:732-688-1487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services