NPIMap

Organization Active NPI

Guardian Angel Healthcare, LLC

Doing business as Jeremiah's Place

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Henderson, NC
National Provider Identifier
1346396793
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL091077 Issued in NC
Legal business name
GUARDIAN ANGEL HEALTHCARE, LLC
Doing business as
Jeremiah's Place
Practice address
314 S Garnett St
Suite 202
Henderson, NC 27536-4538
Phone
(252) 492-9205
Fax
(252) 492-9088
NPI assigned
Jan 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Cornelius Williams
Title
President - Registered Agent
Phone
(252) 257-9349

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL091077 NC Primary

Addresses

Primary practice location

314 S Garnett St
Suite 202
Henderson, NC 27536-4538

Mailing address

107 Currin LN
Warrenton, NC 27589-2249
Phone (252) 257-9349

Other identifiers 1

IdentifierTypeStateIssuer
7805648MedicaidNC

Other names 1

  • Jeremiah's Place Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Guardian Angel Healthcarellc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

314 S Garnett St
Ste 202
Henderson, NC 27536
Phone (252) 492-9205

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346396793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 CURRIN LN",
            "city": "WARRENTON",
            "state": "NC",
            "postal_code": "275892249",
            "telephone_number": "252-257-9349",
            "fax_number": "252-492-9088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 S GARNETT ST",
            "address_2": "SUITE 202",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275364538",
            "telephone_number": "252-492-9205",
            "fax_number": "252-492-9088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_title_or_position": "PRESIDENT - REGISTERED AGENT",
        "authorized_official_telephone_number": "252-257-9349",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL091077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805648",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jeremiah's Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.