# GUARDIAN ANGEL HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jeremiah's Place
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346396793
- **Authorized official:** MR. CORNELIUS WILLIAMS (PRESIDENT - REGISTERED AGENT)
- **Authorized official phone:** (252) 257-9349

## Contact information

- **Practice address:** 314 S GARNETT ST, SUITE 202, HENDERSON, NC 27536-4538
- **Practice address phone:** (252) 492-9205
- **Practice address fax:** (252) 492-9088
- **Mailing address:** 107 CURRIN LN, WARRENTON, NC 27589-2249
- **Mailing address phone:** (252) 257-9349
- **Mailing address fax:** (252) 492-9088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL091077 | NC | Yes |

## Other

- **Enumeration date:** 01/26/2007
- **Last updated:** 08/22/2020