Provider Demographics
NPI:1164698429
Name:ANGELIC HEARTZ CARE FACILITY
Entity Type:Organization
Organization Name:ANGELIC HEARTZ CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:O
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-436-0270
Mailing Address - Street 1:914 DIXIE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-6620
Mailing Address - Country:US
Mailing Address - Phone:336-436-0270
Mailing Address - Fax:336-436-0270
Practice Address - Street 1:415 RAUHUT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2457
Practice Address - Country:US
Practice Address - Phone:336-436-0270
Practice Address - Fax:336-436-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness