Provider Demographics
NPI:1396042057
Name:HEAVELY ANGELS
Entity Type:Organization
Organization Name:HEAVELY ANGELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-432-1861
Mailing Address - Street 1:3725 ANITA LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9412
Mailing Address - Country:US
Mailing Address - Phone:336-617-3789
Mailing Address - Fax:
Practice Address - Street 1:3725 ANITA LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-9412
Practice Address - Country:US
Practice Address - Phone:336-617-3789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-988320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities