Provider Demographics
NPI:1407014962
Name:ANGEL START OF DURHAM
Entity Type:Organization
Organization Name:ANGEL START OF DURHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-549-1659
Mailing Address - Street 1:3600 N DUKE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1709
Mailing Address - Country:US
Mailing Address - Phone:919-471-1800
Mailing Address - Fax:919-471-1877
Practice Address - Street 1:3600 N DUKE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1709
Practice Address - Country:US
Practice Address - Phone:919-471-1800
Practice Address - Fax:919-471-1877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASD DURHAMII
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1308251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601777Medicaid