MEDICARE: HOLY ANGELS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	MHL-036-041	NC
2	251C00000X	Developmentally Disabled Services Day Training Agency	MHL-036-310	NC
3	251J00000X	Nursing Care Agency
4	251S00000X	Community/Behavioral Health Agency
5	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL-036-112	NC
6	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL-036-058	NC
7	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL-036-111	NC
8	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL-036-041	NC
9	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL-036-012	NC

General Provider Information

NPI Number	:	1619310851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLY ANGELS INC

Provider Business Mailing Address
First Line	:	6600 W WILKINSON BLVD
Second Line	:
City	:	BELMONT
State	:	NC
Zip	:	28012-2796
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 W WILKINSON BLVD
Second Line	:
City	:	BELMONT
State	:	NC
Zip	:	28012-2796
Country	:	US
Telephone Number	:	704-825-4161
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	REGINA MOODY
Credential	:
Telephone Number	:	704-825-4161

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	03/17/2018

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