Provider Demographics
NPI:1417490202
Name:ANGELS AT HEART ASSISTED LIVING
Entity Type:Organization
Organization Name:ANGELS AT HEART ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARETTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-232-1770
Mailing Address - Street 1:140 KENT RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147
Mailing Address - Country:US
Mailing Address - Phone:704-232-1770
Mailing Address - Fax:704-727-4979
Practice Address - Street 1:140 KENT ROAD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147
Practice Address - Country:US
Practice Address - Phone:704-431-4468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-080-020251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization