Provider Demographics
NPI:1477632446
Name:MCAULEY CIRCLE
Entity Type:Organization
Organization Name:MCAULEY CIRCLE
Other - Org Name:HOLY ANGELS SERVICES INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:704-825-4161
Mailing Address - Street 1:6600 W WILKINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-2796
Mailing Address - Country:US
Mailing Address - Phone:704-825-4161
Mailing Address - Fax:704-825-0401
Practice Address - Street 1:6600 W WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-2796
Practice Address - Country:US
Practice Address - Phone:704-825-4161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC036-037315P00000X
NCMHL-036-037320600000X, 320900000X
NCMHL 036-012320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC340602WMedicaid
NC3408854Medicaid