Provider Demographics
NPI:1902622798
Name:ANGELS FOSTER FAMILY AGENCY
Entity type:Organization
Organization Name:ANGELS FOSTER FAMILY AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-283-8100
Mailing Address - Street 1:9295 FARNHAM ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1255
Mailing Address - Country:US
Mailing Address - Phone:619-283-8100
Mailing Address - Fax:
Practice Address - Street 1:9295 FARNHAM ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1255
Practice Address - Country:US
Practice Address - Phone:619-283-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251B00000XAgenciesCase Management
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No385H00000XRespite Care FacilityRespite Care