Provider Demographics
NPI:1992292346
Name:2300 ANGUS LLC
Entity type:Organization
Organization Name:2300 ANGUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANACE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-970-1904
Mailing Address - Street 1:517 PARK ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4739
Mailing Address - Country:US
Mailing Address - Phone:434-970-1904
Mailing Address - Fax:434-970-2044
Practice Address - Street 1:2300 ANGUS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2630
Practice Address - Country:US
Practice Address - Phone:434-970-1904
Practice Address - Fax:434-970-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACRF-317320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA600894797Medicaid