Healthcare Provider Details

I. General information

NPI: 1992070973
Provider Name (Legal Business Name): SHELBY'S GUARDIAN ANGELS II OF NC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 DEMBRIGH LN
CHARLOTTE NC
28262-2554
US

IV. Provider business mailing address

8511 DAVIS LAKE PKWY STE C6-186
CHARLOTTE NC
28269-0536
US

V. Phone/Fax

Practice location:
  • Phone: 330-430-9977
  • Fax: 330-452-4300
Mailing address:
  • Phone: 330-430-9977
  • Fax: 330-452-4300

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 TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. HELEN MARIE MITCHELL SHELBY
Title or Position: CO CEO
Credential:
Phone: 330-327-6332