# MY GUARDIAN ANGEL FAMILY CARE HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669070215
- **Authorized official:** VERNON BRYANT (OWNER)
- **Authorized official phone:** (252) 813-1939

## Contact information

- **Practice address:** 514 COKEY ROAD, ROCKY MOUNT, NC 27801
- **Practice address phone:** (252) 977-3368
- **Practice address fax:** (252) 977-3368
- **Mailing address:** 2001 VERNON ROAD, ROCKY MOUNT, NC 27801-6348
- **Mailing address phone:** (252) 977-3368
- **Mailing address fax:** (252) 977-3368

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311Z00000X | Custodial Care Facility | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |
| 347C00000X | Private Vehicle | — | NULL | — |

## Other

- **Enumeration date:** 10/15/2020
- **Last updated:** 10/15/2020