Organization
ANGEL FAMILY CARE, LLC
Active
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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