Organization
HEAVENLY ANGELS GROUP HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANTOINETTA DEMTRIA FULTON (ONWER/ DIRECTOR)
(336) 230-0808
Entity
Organization
Contact information
Practice address
3725 ANITA LN, GREENSBORO, NC 27405-9412
(336) 358-2137
(336) 358-2136
Mailing address
503 W MCGEE ST, GREENSBORO, NC 27401-2702
(336) 230-0808
(336) 230-0842
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-041-895
NC
Other
Enumeration date
03/05/2009
Last updated
03/05/2009
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