Provider Demographics
NPI:1114948031
Name:ANGEL STAR HOME HEALTH, INC.
Entity Type:Organization
Organization Name:ANGEL STAR HOME HEALTH, INC.
Other - Org Name:ANGEL STAR HOME HEALTH,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:LAVON
Authorized Official - Last Name:MCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-596-0162
Mailing Address - Street 1:9816 NOTTINGHILL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5006
Mailing Address - Country:US
Mailing Address - Phone:704-596-0162
Mailing Address - Fax:704-596-0869
Practice Address - Street 1:5100 REAGAN DR
Practice Address - Street 2:SUITE 15
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-3190
Practice Address - Country:US
Practice Address - Phone:704-596-0162
Practice Address - Fax:704-596-0869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 163WC1500X, 163WH0200X, 163WI0500X, 251E00000X, 3747P1801X, 374U00000X, 376K00000X
NC332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106549MedicaidLICENSED CLINICAL SOCIAL
NC7704443MedicaidDME ID
NC3408430MedicaidCAPS
NC6006020MedicaidOUTPATIENT MENTAL HEALTH
NC5517250001Medicare NSC
NC7704443MedicaidDME ID