Provider Demographics
NPI:1053143479
Name:ANGEL CENTER LLC
Entity type:Organization
Organization Name:ANGEL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANHAR
Authorized Official - Middle Name:BADRI
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-898-8368
Mailing Address - Street 1:12648 LEYTE ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6791
Mailing Address - Country:US
Mailing Address - Phone:763-898-8368
Mailing Address - Fax:
Practice Address - Street 1:7260 UNIVERSITY AVE NE STE 315
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3129
Practice Address - Country:US
Practice Address - Phone:763-898-8368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency