Heavenly Angels Group Home, Inc

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL-041-895 Issued in NC

Legal business name

HEAVENLY ANGELS GROUP HOME, INC

Practice address

3725 Anita LN
Greensboro, NC 27405-9412

Phone

(336) 358-2137

Fax

(336) 358-2136

NPI assigned

Mar 5, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Antoinetta Demtria Fulton

Title

Onwer/ Director

Phone

(336) 230-0808

Specialties & licenses 1

Addresses

Tax ID family

Heavely Angels2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Heavely Angels

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Greensboro, NC
  • NPI 1396042057
  NPD tax ID

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

{
    "created_epoch": "1236211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236211200000",
    "number": "1457591356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 W MCGEE ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274012702",
            "telephone_number": "336-230-0808",
            "fax_number": "336-230-0842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3725 ANITA LN",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274059412",
            "telephone_number": "336-358-2137",
            "fax_number": "336-358-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVENLY ANGELS GROUP HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-05",
        "last_updated": "2009-03-05",
        "status": "A",
        "authorized_official_last_name": "FULTON",
        "authorized_official_first_name": "ANTOINETTA",
        "authorized_official_middle_name": "DEMTRIA",
        "authorized_official_title_or_position": "ONWER/ DIRECTOR",
        "authorized_official_telephone_number": "336-230-0808",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-041-895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolyn S Heath, RD, LDN
• Jahci Heath
• Katherine Boedicker Heath, RN
• Spencer McKan Heath III
• Heavely Angels
• Heavenly Embrace
• Heavenly Healthcare Agency, Inc.
• Heavenlygates, Inc.
• Stephen Perry Hebard, LPC
• Donald Vincent Heck, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; 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.