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General NPI Number Information
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NPI Number | 1376363341
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Entity Type | Organization
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Legal Business Name | ANGELS CARE ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 703 JIM BLAKE RD
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City | JACKSONVILLE
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State | NC
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Zip | 28540-7705
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Country | US
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Telephone | 910-967-0374
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Fax | 910-469-1275
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Provider Business Mailing Address
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Address Line | 703 JIM BLAKE RD
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City | JACKSONVILLE
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State | NC
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Zip | 28540-7705
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Country | US
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Telephone | 910-967-0374
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Fax | 910-469-1275
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Authorized Official
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Title or Position | OWNER
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Name | KILEY DONITA DAUGHTRY
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Credential |
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Telephone | 910-967-0374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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