Provider Demographics
NPI:1366675142
Name:ANGELS REACH DEVELOPMENTAL ENRICHMENT CENTER
Entity type:Organization
Organization Name:ANGELS REACH DEVELOPMENTAL ENRICHMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUZARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-828-5276
Mailing Address - Street 1:8325 W 24TH AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1880
Mailing Address - Country:US
Mailing Address - Phone:305-828-5276
Mailing Address - Fax:
Practice Address - Street 1:8325 W 24TH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1880
Practice Address - Country:US
Practice Address - Phone:305-828-5276
Practice Address - Fax:305-828-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health