Organization
LAKEWOOD
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) 829-4410
Entity
Organization
Contact information
Practice address
302 GREENWOOD PL, BELMONT, NC 28012-2911
(704) 829-4410
Mailing address
PO BOX 710, BELMONT, NC 28012-0710
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-036-058
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619310851
STATE FUNDS
NC
05
—
3408854
—
NC
05
—
7802691
—
NC
Enumeration date
09/18/2009
Last updated
08/30/2017
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