Organization
MICAH'S ANGELS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULETTE L WASHINGTON (OWNER)
(704) 712-8454
Entity
Organization
Contact information
Practice address
11822 STEWARTS CROSSING DR, CHARLOTTE, NC 28215-5072
(704) 712-8454
(704) 532-4414
Mailing address
11822 STEWARTS CROSSING DR, CHARLOTTE, NC 28215-5072
(704) 712-8454
(704) 532-4414
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-060-846
NC
Other
Enumeration date
03/12/2007
Last updated
06/24/2008
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