NPIMap

Organization Active NPI

Guardian Angel Healthcare,LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Henderson, NC
National Provider Identifier
1821146069
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL091065 Issued in NC
Legal business name
GUARDIAN ANGEL HEALTHCARE,LLC
Practice address
270 Charles St
Henderson, NC 27536-4328
Phone
(252) 492-1152
NPI assigned
Jan 6, 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
Presidentregistered Agent
Phone
(252) 257-9349

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL091065 NC Primary

Addresses

Primary practice location

270 Charles St
Henderson, NC 27536-4328

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
6603653MedicaidNC

Other names 1

  • Charles Street 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": "1598054400000",
    "number": "1821146069",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 CHARLES ST",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275364328",
            "telephone_number": "252-492-1152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HEALTHCARE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CORNELIUS",
        "authorized_official_title_or_position": "PRESIDENTREGISTERED AGENT",
        "authorized_official_telephone_number": "252-257-9349",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL091065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603653",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charles Street Facility",
            "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.