Provider Demographics
NPI:1053880021
Name:ANGELO'S CARE HOME, INC
Entity type:Organization
Organization Name:ANGELO'S CARE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-521-1895
Mailing Address - Street 1:10091 US HIGHWAY 74 W
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-8936
Mailing Address - Country:US
Mailing Address - Phone:910-521-1895
Mailing Address - Fax:910-521-7220
Practice Address - Street 1:707 UNION CHAPEL RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8689
Practice Address - Country:US
Practice Address - Phone:910-521-1895
Practice Address - Fax:910-521-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care