Provider Demographics
NPI:1992070973
Name:SHELBY'S GUARDIAN ANGELS II OF NC LLC
Entity type:Organization
Organization Name:SHELBY'S GUARDIAN ANGELS II OF NC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MITCHELL SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-327-6332
Mailing Address - Street 1:8511 DAVIS LAKE PKWY STE C6-186
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0536
Mailing Address - Country:US
Mailing Address - Phone:330-430-9977
Mailing Address - Fax:330-452-4300
Practice Address - Street 1:2004 DEMBRIGH LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2554
Practice Address - Country:US
Practice Address - Phone:330-430-9977
Practice Address - Fax:330-452-4300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBY'S GUARDIAN ANGELS II OF NC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-09
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)