Healthcare Provider Details

I. General information

NPI: 1639320237
Provider Name (Legal Business Name): ANGEL STAR HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N DUKE ST SUITE 103
DURHAM NC
27704-1709
US

IV. Provider business mailing address

9816 NOTTINGHILL LN
CHARLOTTE NC
28269-5006
US

V. Phone/Fax

Practice location:
  • Phone: 919-471-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. VERONICA MCLENDON
Title or Position: CEO
Credential:
Phone: 704-840-9023