Provider Demographics
NPI:1881174183
Name:ANGEL SUPPORT COORDINATION LLC
Entity type:Organization
Organization Name:ANGEL SUPPORT COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:THORA
Authorized Official - Last Name:JOHNSON APPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-252-3589
Mailing Address - Street 1:40 WATSON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3304
Mailing Address - Country:US
Mailing Address - Phone:862-252-3589
Mailing Address - Fax:
Practice Address - Street 1:40 WATSON AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3304
Practice Address - Country:US
Practice Address - Phone:862-252-3589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty