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General NPI Number Information
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NPI Number | 1639219058
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Entity Type | Organization
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Legal Business Name | ANGELS FAMILY CARE I
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 809 WICKER ST
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City | BURLINGTON
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State | NC
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Zip | 27217-2362
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Country | US
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Telephone | 336-570-2990
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Fax | 336-228-9376
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Provider Business Mailing Address
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Address Line | 809 WICKER ST
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City | BURLINGTON
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State | NC
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Zip | 27217-2362
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Country | US
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Telephone | 336-570-2990
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Fax | 336-228-9376
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Authorized Official
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Title or Position | ADMINISTRATOR-OWNER
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Name | MR. MICHAEL J GRAVES
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Credential |
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Telephone | 336-570-2990
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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 | FCL001064
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License Number State | NC
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