Provider Demographics
NPI:1942435011
Name:PEARLS ANGEL CARE INC
Entity Type:Organization
Organization Name:PEARLS ANGEL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:910-257-6060
Mailing Address - Street 1:1545 STACKHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6356
Mailing Address - Country:US
Mailing Address - Phone:910-257-6060
Mailing Address - Fax:
Practice Address - Street 1:231 WESTLAKE ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-4861
Practice Address - Country:US
Practice Address - Phone:910-257-6060
Practice Address - Fax:910-487-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6603332385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603332Medicaid