Micah's Angels Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

MHL-060-846 Issued in NC

Legal business name

MICAH'S ANGELS INC

Practice address

11822 Stewarts Crossing Dr
Charlotte, NC 28215-5072

Phone

(704) 712-8454

Fax

(704) 532-4414

NPI assigned

Mar 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paulette L Washington

Title

Owner

Phone

(704) 712-8454

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1033241005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11822 STEWARTS CROSSING DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282155072",
            "telephone_number": "704-712-8454",
            "fax_number": "704-532-4414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11822 STEWARTS CROSSING DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282155072",
            "telephone_number": "704-712-8454",
            "fax_number": "704-532-4414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICAH'S ANGELS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "PAULETTE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-712-8454"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-060-846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Davena Mgbeokwere, LCSW
• Mhoh Foundation
• Carolyn Mitchell Miales, LPCA
• Lesia Mialik, NP
• Simeng Miao, MD
• Micah's Management Services
• Micah's Management Services (Micah's Angels Inc.)
• Micah's Medical Supplies
• Michael a Derose DDS PA
• Michael a Derose DDS PA

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.