34D0722088 CLIA NUMBER - HOLY ANGELS, INC

Laboratory Demographics

CLIA Code: 34D0722088
Facility Name: HOLY ANGELS, INC
Facility Address: 6600 EAST WILKINSON BOULEVARD
BELMONT, NC
ZIP 28012
Facility Phone: 704 825-4161
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: C ELLIS FISHER
NPI Number: 1619310851
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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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
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	9/1/2024
Certificate Expiration Date	8/31/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	C ELLIS FISHER

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This page was last updated on: 9/29/2025