Organization
ANGEL GATE HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES BESONG DNP (DIRECTOR)
(240) 491-2868
Entity
Organization
Contact information
Practice address
12403 HATCHWAY CT, WOODBRIDGE, VA 22192-2114
(240) 491-2868
Mailing address
12403 HATCHWAY CT, WOODBRIDGE, VA 22192-2114
(240) 491-2868
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4397
—
VA
Enumeration date
07/28/2021
Last updated
07/28/2021
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