Provider Demographics
NPI:1588366900
Name:ANGELS OF MERCY HOME AND HEALTH CARE, LLC
Entity type:Organization
Organization Name:ANGELS OF MERCY HOME AND HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAN-MICHEAL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-775-9350
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-0595
Mailing Address - Country:US
Mailing Address - Phone:910-775-9350
Mailing Address - Fax:910-775-9351
Practice Address - Street 1:564 CANDY PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-1306
Practice Address - Country:US
Practice Address - Phone:910-775-9350
Practice Address - Fax:910-775-9351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty