Provider Demographics
NPI:1831490192
Name:ANGELIC HOME CARE, INC
Entity Type:Organization
Organization Name:ANGELIC HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-262-3324
Mailing Address - Street 1:325 MCGILL AVE NW
Mailing Address - Street 2:SUITE 516
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6181
Mailing Address - Country:US
Mailing Address - Phone:704-262-3324
Mailing Address - Fax:
Practice Address - Street 1:325 MCGILL AVE NW
Practice Address - Street 2:SUITE 516
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6181
Practice Address - Country:US
Practice Address - Phone:704-262-3324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4181253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC4181OtherNC DHHS LICENSE FOR HOME CARE AGENCY