ANGEL INTERVENTION SERVICES LLC NPI 1801311121

NPI Information

NPI: 1801311121
Provider Name: ANGEL INTERVENTION SERVICES LLC
Classification: Clinic/Center - 261QR0401X
Entity Type: Organization

Specialization: Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)

CLIA Number: 36D2131233

Address:
123 S WASHINGTON ST
VAN WERT, OH
ZIP 45891
Phone: (419) 771-1050
Get Directions

ANGEL INTERVENTION SERVICES LLC is a rehabilitation and comprehensive outpatient rehabilitation facility (corf) clinic center in Van Wert, OH. ANGEL INTERVENTION SERVICES LLC NPI is 1801311121. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

123 S WASHINGTON ST
VAN WERT, OH
ZIP 45891-707
Phone: (419) 771-1050

The provider's authorized official is Holly Lyn Conklin .
The authorized official title is Ceo/owner and has the following contact phone number (918) 500-2570.

The CLIA number assigned to this NPI record is 36D2131233 - independent with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/8/2017 and was last updated on 7/12/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101Y00000X	Counselor		No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	No
3	251B00000X	Case Management		No
4	324500000X	Substance Abuse Rehabilitation Facility		No
5	261QR0401X	Clinic/Center	Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0427664	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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