Provider Demographics
NPI:1912917758
Name:KATRINA W ANGEL
Entity Type:Organization
Organization Name:KATRINA W ANGEL
Other - Org Name:MORNING STAR FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-300-1782
Mailing Address - Street 1:PO BOX 653
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28042-0653
Mailing Address - Country:US
Mailing Address - Phone:704-538-8680
Mailing Address - Fax:
Practice Address - Street 1:737 SUGAR HILL RD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:NC
Practice Address - Zip Code:28090-9138
Practice Address - Country:US
Practice Address - Phone:704-538-8680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802221Medicaid