Provider Demographics
NPI:1487718540
Name:ANGELO'S CARE HOME, INC.
Entity type:Organization
Organization Name:ANGELO'S CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-521-1895
Mailing Address - Street 1:10091 US HIGHWAY 74 W
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-8936
Mailing Address - Country:US
Mailing Address - Phone:910-521-1895
Mailing Address - Fax:910-521-7220
Practice Address - Street 1:707 UNION CHAPEL RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8689
Practice Address - Country:US
Practice Address - Phone:910-521-1895
Practice Address - Fax:910-521-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251J00000X, 251S00000X, 253Z00000X
NCHC4768251E00000X, 253Z00000X
NCMHL-078-304251S00000X
NCMHL-078-275320600000X, 385H00000X
NCMHL-078-138320700000X, 385H00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409420Medicaid