Organization
ANGELS DDA CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J. GRAVES (OWNER)
(336) 228-9376
Entity
Organization
Contact information
Practice address
305 N FISHER ST, BURLINGTON, NC 27217-2425
(336) 570-2990
(336) 228-9376
Mailing address
305 N FISHER ST, BURLINGTON, NC 27217-2425
(336) 570-2990
(336) 228-9376
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
MHL-001-097
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7803571
—
NC
Enumeration date
03/26/2007
Last updated
08/22/2020
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