Organization
GARY
Active
Parent organization
HOLY ANGELS INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
HOLY ANGELS INC
Authorized official
SHANNON CHILDRESS (CHIEF CLINICAL OFFICER)
(704) 825-4161
Entity
Organization
Contact information
Practice address
301 MCAULEY CIRCLE, BELMONT, NC 28012-0710
(704) 825-4161
(704) 825-0401
Mailing address
6600 W WILKINSON BLVD, BELMONT, NC 28012-2796
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
311ZA0620X
Adult Care Home Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL-036-112
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619310851
STATE FUNDS
NC
05
—
7803424
—
NC
Enumeration date
10/05/2009
Last updated
08/30/2017
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