Provider Demographics
NPI:1639219058
Name:ANGELS FAMILY CARE I
Entity Type:Organization
Organization Name:ANGELS FAMILY CARE I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-570-2990
Mailing Address - Street 1:809 WICKER ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2362
Mailing Address - Country:US
Mailing Address - Phone:336-570-2990
Mailing Address - Fax:336-228-9376
Practice Address - Street 1:809 WICKER ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2362
Practice Address - Country:US
Practice Address - Phone:336-570-2990
Practice Address - Fax:336-228-9376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL001064311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803572Medicaid