Provider Demographics
NPI:1013732379
Name:MICHAEL'S ANGELS HOUSE OF RESILIENCE, INC
Entity type:Organization
Organization Name:MICHAEL'S ANGELS HOUSE OF RESILIENCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-437-7234
Mailing Address - Street 1:PO BOX 1454
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1454
Mailing Address - Country:US
Mailing Address - Phone:919-437-7234
Mailing Address - Fax:252-563-5736
Practice Address - Street 1:2109 SAINT ANDREW ST STE 11
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-2146
Practice Address - Country:US
Practice Address - Phone:919-437-7234
Practice Address - Fax:252-563-5736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health