34D0722088 CLIA NUMBER - HOLY ANGELS, INC

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Laboratory Demographics

CLIA Number: 34D0722088

Facility Name: HOLY ANGELS, INC

Facility Address:
6600 EAST WILKINSON BOULEVARD
BELMONT, NC
ZIP 28012
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Facility Phone Number: 704 825-4161

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1619310851

Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

CLIA Record

Field Name	Field Value
CLIA Number	34D0722088
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	HOLY ANGELS, INC
Street	6600 EAST WILKINSON BOULEVARD
City	BELMONT
State	NC
ZIP	28012
Phone	704 825-4161
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024