NPIMap

Organization Active NPI

Angel Intervention Services LLC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Van Wert, OH
National Provider Identifier
1801311121
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
ANGEL INTERVENTION SERVICES LLC
Practice address
123 S Washington St
Van Wert, OH 45891-1707
Phone
(419) 771-1050
NPI assigned
Aug 8, 2017
Last updated
Jul 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Holly Lyn Conklin, CDCA II, CDAC, CIPNPI 1437713492
Title
Ceo/Owner
Phone
(918) 500-2570

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Case Management Agency 251B00000X NU
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X NU Primary
Substance Abuse Rehabilitation Facility 324500000X NU

Addresses

Primary practice location

123 S Washington St
Van Wert, OH 45891-1707

Mailing address

123 S Washington St
Van Wert, OH 45891-1707
Phone (800) 430-2995

Other practice location 1

121 S Washington St
Van Wert, OH 45891-1707
Phone (419) 771-1050

Other identifiers 1

IdentifierTypeStateIssuer
0427664MedicaidOH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2131233Angel Intervention Services LLC123 S Washington St, Van Wert, OH 45891Certificate of waiverMay 23, 2027

National Provider Directory

National Provider Directory

Locations

111 E Main St
Ste 202
Van Wert, OH 45891

121 S Washington St
Van Wert, OH 45891
Phone 4197711050 ext. 3

123 S Washington St
Van Wert, OH 45891
Phone (419) 771-1050

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1801311121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 S WASHINGTON ST",
            "city": "VAN WERT",
            "state": "OH",
            "postal_code": "458911707",
            "telephone_number": "800-430-2995",
            "fax_number": "419-771-1051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 S WASHINGTON ST",
            "city": "VAN WERT",
            "state": "OH",
            "postal_code": "458911707",
            "telephone_number": "419-771-1050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 S Washington St",
            "address_purpose": "LOCATION",
            "city": "Van Wert",
            "state": "OH",
            "postal_code": "458911707",
            "country_code": "US",
            "telephone_number": "419-771-1050",
            "fax_number": "419-771-1051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ANGEL INTERVENTION SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-08",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "CONKLIN",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "918-500-2570",
        "authorized_official_credential": "CDCA II, CDAC, CIP"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0427664",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Wert, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.