Organization
ANGEL'S ADULT GROUP HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABEL DEFOREST (MANAGER/OWNER)
(480) 889-4288
Entity
Organization
Contact information
Practice address
15462 S 47TH PL, PHOENIX, AZ 85044-4965
(480) 889-4288
(480) 546-3122
Mailing address
1418 E BRIARWOOD TER, PHOENIX, AZ 85048-8692
(480) 889-4288
(480) 546-3122
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
08/19/2022
Last updated
08/19/2022
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