MEDICARE: ANGELS DREAM FOUNDATION

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	101Y00000X	Counselor		NC

General Provider Information

NPI Number	:	1902151194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS DREAM FOUNDATION

Provider Business Mailing Address
First Line	:	1800 CAMDEN RD
Second Line	:	SUITE 106
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4690
Country	:	US
Telephone Number	:	401-499-6558
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 CAMDEN RD
Second Line	:	SUITE 106
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4690
Country	:	US
Telephone Number	:	401-499-6558
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. DULCE DELGADO CUSTODIO
Credential	:	BS
Telephone Number	:	401-499-6558

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	07/13/2012

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Directions to “ANGELS DREAM FOUNDATION ” Practice Location

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