# GUARDIAN ANGEL HEALTHCARE,LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Charles Street Facility
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821146069
- **Authorized official:** MR. CORNELIUS WILLIAMS (PRESIDENTREGISTERED AGENT)
- **Authorized official phone:** (252) 257-9349

## Contact information

- **Practice address:** 270 CHARLES ST, HENDERSON, NC 27536-4328
- **Practice address phone:** (252) 492-1152
- **Mailing address:** 107 CURRIN LN, WARRENTON, NC 27589-2249
- **Mailing address phone:** (252) 257-9349

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL091065 | NC | Yes |

## Other

- **Enumeration date:** 01/06/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6603653 | — | NC |