Organization
HOLY ANGELS SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANNON WORTMAN PRINCE B.S. (VICE PRESIDENT OF CLINICAL SERVICES)
(704) 829-4418
Entity
Organization
Contact information
Practice address
6600 E WILKINSON BLVD, BELMONT, NC 28012-4707
(704) 829-4418
Mailing address
6600 E WILKINSON BLVD, BELMONT, NC 28012-4707
(704) 829-4418
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL-036-012
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7211943
—
NC
Enumeration date
05/09/2008
Last updated
08/31/2017
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