Brenda W Bryan

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

MHL033046 Issued in NC

Legal business name

BRENDA W BRYAN

Doing business as

My Guardian Angel Group Home

Practice address

2001 Vernon Rd
Rocky Mount, NC 27801

Phone

(252) 977-1956

Fax

(252) 977-1956

NPI assigned

Nov 21, 2007

Organization subpart

No

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

Authorized official

Name

Brenda Bryant

Title

Owner

Phone

(252) 977-1956

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• My Guardian Angel Group Home Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vernon Bryant

  • Adult Care Home Facility
  • Rocky Mount, NC
  • NPI 1952845174
  NPD (past)

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

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217548800000",
    "number": "1376724039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 VERNON RD",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "27801",
            "telephone_number": "252-977-1956",
            "fax_number": "252-977-1956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 VERNON RD",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "27801",
            "telephone_number": "252-977-1956",
            "fax_number": "252-977-1956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENDA W BRYAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-21",
        "last_updated": "2008-08-01",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "252-977-1956"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL033046",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL033046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805933",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Guardian Angel Group Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Rocky Mount, NC
• Providers in Rocky Mount, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2008; 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.