Provider Demographics
NPI:1376363341
Name:ANGELS CARE ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:ANGELS CARE ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:DONITA
Authorized Official - Last Name:DAUGHTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-967-0374
Mailing Address - Street 1:703 JIM BLAKE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-7705
Mailing Address - Country:US
Mailing Address - Phone:910-967-0374
Mailing Address - Fax:910-469-1275
Practice Address - Street 1:703 JIM BLAKE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-7705
Practice Address - Country:US
Practice Address - Phone:910-967-0374
Practice Address - Fax:910-469-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility