MEDICARE: ANGELIC COMMUNITY & FAMILY SERVICES OF CUMBERLAND COUNT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1710130299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELIC COMMUNITY & FAMILY SERVICES OF CUMBERLAND COUNT

Provider Business Mailing Address
First Line	:	1014 HAY ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5316
Country	:	US
Telephone Number	:	910-223-0120
Fax Number	:	910-223-0123

Provider Business Practice Location Address
First Line	:	1014 HAY ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5316
Country	:	US
Telephone Number	:	910-223-0120
Fax Number	:	910-223-0123

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	ERIC BERNARD MITCHELL
Credential	:
Telephone Number	:	910-223-0120

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/29/2008

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