Organization
ANGEL FAMILY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHANTELLE EZINNE OGUADIMMA LAC (CHIEF EXECUTIVE OFFICER)
(480) 720-3393
Entity
Organization
Contact information
Practice address
28370 N GOLD LN, SAN TAN VALLEY, AZ 85143-6059
(480) 720-3393
Mailing address
28370 N GOLD LN, SAN TAN VALLEY, AZ 85143-6059
(480) 720-3393
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/06/2019
Last updated
06/21/2021
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