Provider Demographics
NPI:1861100646
Name:UNDER ANGEL'S WINGS RECOVERY CENTER, LLC
Entity type:Organization
Organization Name:UNDER ANGEL'S WINGS RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DELBRUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:917-362-4332
Mailing Address - Street 1:1588 E 58TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4102
Mailing Address - Country:US
Mailing Address - Phone:917-620-0105
Mailing Address - Fax:
Practice Address - Street 1:5411 2ND AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2664
Practice Address - Country:US
Practice Address - Phone:718-374-5484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center