Provider Demographics
NPI:1265689285
Name:ANGEL HEART SPEECH & LANGUAGE SERVICES, INC
Entity Type:Organization
Organization Name:ANGEL HEART SPEECH & LANGUAGE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYLOU
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:336-312-2705
Mailing Address - Street 1:6711 BUGLE RUN
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9753
Mailing Address - Country:US
Mailing Address - Phone:336-312-2705
Mailing Address - Fax:336-644-1148
Practice Address - Street 1:6711 BUGLE RUN
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9753
Practice Address - Country:US
Practice Address - Phone:336-312-2705
Practice Address - Fax:336-644-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3515235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411116Medicaid