Provider Demographics
NPI:1528657954
Name:DESERT ANGELS BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:DESERT ANGELS BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWOSIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-494-1419
Mailing Address - Street 1:25210 S WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-6408
Mailing Address - Country:US
Mailing Address - Phone:480-494-1419
Mailing Address - Fax:800-758-1538
Practice Address - Street 1:20148 N DONITHAN WAY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2428
Practice Address - Country:US
Practice Address - Phone:480-494-1419
Practice Address - Fax:800-758-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children