Provider Demographics
NPI:1770031130
Name:HOLY ANGELS INC
Entity Type:Organization
Organization Name:HOLY ANGELS INC
Other - Org Name:HOLY ANGELS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:704-829-4410
Mailing Address - Street 1:6600 W WILKINSON BLVD
Mailing Address - Street 2:PO BOX 710
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:704-825-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202981364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty