Provider Demographics
NPI:1740727338
Name:HEAVEN'S ANGELS RESIDENTIAL SERVICES
Entity type:Organization
Organization Name:HEAVEN'S ANGELS RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-742-5404
Mailing Address - Street 1:12245 BEECH DALY RD
Mailing Address - Street 2:STE. 40736
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-3200
Mailing Address - Country:US
Mailing Address - Phone:734-742-5404
Mailing Address - Fax:888-325-1688
Practice Address - Street 1:30120 FORD RD STE C
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2396
Practice Address - Country:US
Practice Address - Phone:734-742-5404
Practice Address - Fax:888-325-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0855X, 320800000X, 320900000X, 174200000X, 253Z00000X, 261QD1600X, 261QM0850X, 385H00000X, 385HR2055X, 385HR2060X, 385HR2065X
MIAS820381239320600000X, 320700000X, 320900000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child