Healthcare Provider Details

I. General information

NPI: 1588253983
Provider Name (Legal Business Name): LIFES ANGEL GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 GET A WAY LN
BAHAMA NC
27503-9650
US

IV. Provider business mailing address

211 GET A WAY LN
BAHAMA NC
27503-9650
US

V. Phone/Fax

Practice location:
  • Phone: 919-638-9614
  • Fax:
Mailing address:
  • Phone: 919-638-9614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: DALROYCE KING JONES III
Title or Position: OWNER/OFFICE MANAGER
Credential:
Phone: 919-949-5563