Provider Demographics
NPI:1174336390
Name:ARCH ANGELS SERVICES
Entity type:Organization
Organization Name:ARCH ANGELS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CORDELRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP, MA
Authorized Official - Phone:312-286-6705
Mailing Address - Street 1:10 S RIVERSIDE PLZ STE 875
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3717
Mailing Address - Country:US
Mailing Address - Phone:312-219-2420
Mailing Address - Fax:
Practice Address - Street 1:10 S RIVERSIDE PLZ STE 875
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3717
Practice Address - Country:US
Practice Address - Phone:312-219-2420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health