Provider Demographics
NPI:1326360975
Name:ANGELS OF LIGHT THERAPY CENTER
Entity Type:Organization
Organization Name:ANGELS OF LIGHT THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-670-3218
Mailing Address - Street 1:152 COLD CAMP RD
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28371-9063
Mailing Address - Country:US
Mailing Address - Phone:910-670-3218
Mailing Address - Fax:
Practice Address - Street 1:152 COLD CAMP RD
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:NC
Practice Address - Zip Code:28371-9063
Practice Address - Country:US
Practice Address - Phone:910-670-3218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care