Provider Demographics
NPI:1174330906
Name:ARCH ANGEL'S ENTERRISES II, LLC
Entity type:Organization
Organization Name:ARCH ANGEL'S ENTERRISES II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ARCOLA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-529-2604
Mailing Address - Street 1:144 RETNUH DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-2231
Mailing Address - Country:US
Mailing Address - Phone:336-529-2604
Mailing Address - Fax:
Practice Address - Street 1:144 RETNUH DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-2231
Practice Address - Country:US
Practice Address - Phone:336-529-2604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health