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General NPI Number Information
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NPI Number | 1770031130
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Entity Type | Organization
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Legal Business Name | HOLY ANGELS INC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 6600 W WILKINSON BLVD
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City | BELMONT
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State | NC
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Zip | 28012-2796
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Country | US
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Telephone | 704-825-4161
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Fax | 704-825-0401
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Provider Business Mailing Address
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Address Line | 6600 W WILKINSON BLVD PO BOX 710
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City | BELMONT
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State | NC
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Zip | 28012-2796
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Country | US
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Telephone | 704-825-4161
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Fax | 704-825-0401
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | SHANNON CHILDRESS
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Credential | MBA
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Telephone | 704-829-4410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 202981
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License Number State | NC
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