Angel House LLC.

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

683-14-001 Issued in VA

Legal business name

ANGEL HOUSE LLC.

Practice address

3110 Garland Ave
Richmond, VA 23222-2639

Phone

(804) 228-1540

Fax

(804) 228-1541

NPI assigned

Oct 23, 2006

Organization subpart

No

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

Authorized official

Name

Miss Kamala Benjamin, LCSW

Title

Program Director

Phone

(804) 342-4202

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932282142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3122 W MARSHALL ST",
            "address_2": "SUITE 217",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232304726",
            "telephone_number": "804-342-4202",
            "fax_number": "804-342-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 GARLAND AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232222639",
            "telephone_number": "804-228-1540",
            "fax_number": "804-228-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL HOUSE LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BENJAMIN",
        "authorized_official_first_name": "KAMALA",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "804-342-4202",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "VA",
            "license": "683-14-001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Richmond, VA
• Providers in Richmond, VA by specialty
• Mental Illness Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.