Healthcare Provider Details

I. General information

NPI: 1801147327
Provider Name (Legal Business Name): HOLY ANGELS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W WILKINSON BLVD
BELMONT NC
28012-2796
US

IV. Provider business mailing address

6600 W WILKINSON BLVD
BELMONT NC
28012-2796
US

V. Phone/Fax

Practice location:
  • Phone: 704-825-4161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL-036-012
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-036-012
License Number StateNC

VIII. Authorized Official

Name: REGINA MOODY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 704-829-4402