Provider Demographics
NPI:1417739780
Name:ANGIE'S HOUSE OF LOVE & PATIENCE
Entity Type:Organization
Organization Name:ANGIE'S HOUSE OF LOVE & PATIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:WASHINGTON
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-289-7678
Mailing Address - Street 1:2411 S NC HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28458-8467
Mailing Address - Country:US
Mailing Address - Phone:910-289-7678
Mailing Address - Fax:
Practice Address - Street 1:2411 S NC HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:NC
Practice Address - Zip Code:28458-8467
Practice Address - Country:US
Practice Address - Phone:910-289-7678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home