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General NPI Number Information
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NPI Number | 1588253983
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Entity Type | Organization
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Legal Business Name | LIFES ANGEL GROUP HOME
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 211 GET A WAY LN
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City | BAHAMA
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State | NC
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Zip | 27503-9650
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Country | US
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Telephone | 919-638-9614
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Fax |
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Provider Business Mailing Address
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Address Line | 211 GET A WAY LN
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City | BAHAMA
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State | NC
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Zip | 27503-9650
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Country | US
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Telephone | 919-638-9614
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Fax |
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Authorized Official
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Title or Position | OWNER/OFFICE MANAGER
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Name | DALROYCE KING JONES III
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Credential |
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Telephone | 919-638-9614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home 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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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