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	251S00000X	Community/Behavioral Health Agency
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL-036-012	NC
3	251C00000X	Developmentally Disabled Services Day Training Agency
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	MHL-036-012	NC
5	251J00000X	Nursing Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619310851	OTHER	NC	STATE FUNDS THROUGH PARTNERS MCO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801147327
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	:	704-829-4402

Provider Enumeration Date	:	09/24/2012
Last Update Date	:	03/26/2018

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Practice Location Address:

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BELMONT, NC
28012-2796

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Practice Fax:

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Directions to “HOLY ANGELS INC. ” Practice Location

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