Guardian Light, Inc.

Primary specialty

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

License

MHL-024-056 Issued in NC

Legal business name

GUARDIAN LIGHT, INC.

Practice address

1294 Hallsboro Rd S
Hallsboro, NC 28442-9276

Phone

(910) 646-7143

NPI assigned

Jul 25, 2007

Last updated

Jul 25, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Robertha Powers

Title

Executive Administrator

Phone

(910) 625-5008

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185321600000",
    "number": "1225238421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1877",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284721877",
            "telephone_number": "910-642-8609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1294 HALLSBORO RD S",
            "city": "HALLSBORO",
            "state": "NC",
            "postal_code": "284429276",
            "telephone_number": "910-646-7143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN LIGHT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-25",
        "last_updated": "2007-07-25",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "ROBERTHA",
        "authorized_official_title_or_position": "EXECUTIVE ADMINISTRATOR",
        "authorized_official_telephone_number": "910-625-5008",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-024-056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0961",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bonnie Jean Clemmons, LPC
• Evergreen Behavioral Management, Inc. (Murchison House)
• Evergreen Behavioral Management, Inc. (Murchison House)
• Guardian Light Group Home
• Rha Health Services NC LLC
• Rha Health Services NC LLC

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Hallsboro, NC
• Providers in Hallsboro, 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 Jul 25, 2007; 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.