Organization
ANGELS HOMES
Active
Organization
ANGELS HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH LEE (CLINICAL DIRECTOR)
(602) 503-3909
Entity
Organization
Contact information
Practice address
4419 W BERRIDGE LANE, GLENDALE, AZ 85311
(602) 503-3909
Mailing address
P.O . BOX 998, GLENDALE, AZ 85311
(602) 503-8909
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
BH-4166
AZ
Other
Enumeration date
10/28/2013
Last updated
10/28/2013
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