# ANGEL INTERVENTION SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801311121
- **Authorized official:** HOLLY LYN CONKLIN CDCA II, CDAC, CIP (CEO/OWNER)
- **Authorized official phone:** (918) 500-2570

## Contact information

- **Practice address:** 123 S WASHINGTON ST, VAN WERT, OH 45891-1707
- **Practice address phone:** (419) 771-1050
- **Mailing address:** 123 S WASHINGTON ST, VAN WERT, OH 45891-1707
- **Mailing address phone:** (800) 430-2995
- **Mailing address fax:** (419) 771-1051

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 261QR0401X | Comprehensive Outpatient Rehabilitation Facility (CORF) | — | NULL | Yes |
| 324500000X | Substance Abuse Rehabilitation Facility | — | NULL | — |

## Other

- **Enumeration date:** 08/08/2017
- **Last updated:** 07/12/2023