NPIMap

Organization Active NPI

Guardian Angel Healthcare

  • Community/Behavioral Health Agency
  • Macon, NC
National Provider Identifier
1720136963
Registry record updated Sep 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
GUARDIAN ANGEL HEALTHCARE
Practice address
474 Macon Embro Rd
Macon, NC 27551-9285
Phone
(252) 257-1380
NPI assigned
Jan 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2021

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) 204-1381

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL093034 NC

Addresses

Primary practice location

474 Macon Embro Rd
Macon, NC 27551-9285

Mailing address

PO Box 2002
Henderson, NC 27536-2002
Phone (252) 204-1381

Other identifiers 1

IdentifierTypeStateIssuer
7804755MedicaidNC

Other names 1

  • Willow Road Facility 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.

NPI Registry JSON

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

{
    "created_epoch": "1168041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632528000000",
    "number": "1720136963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2002",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275362002",
            "telephone_number": "252-204-1381",
            "fax_number": "252-598-0051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 MACON EMBRO RD",
            "city": "MACON",
            "state": "NC",
            "postal_code": "275519285",
            "telephone_number": "252-257-1380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-06",
        "last_updated": "2021-09-25",
        "certification_date": "2021-09-25",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_title_or_position": "PRESIDENT REGISTERED AGENT",
        "authorized_official_telephone_number": "252-204-1381",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL093034",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804755",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Road Facility",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Willow Road Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Macon, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2021; 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.