Organization
GUARDIAN ANGEL HEALTHCARE, LLC
Active
Other names
Jeremiah's Place
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORNELIUS WILLIAMS (PRESIDENT - REGISTERED AGENT)
(252) 257-9349
Entity
Organization
Contact information
Practice address
314 S GARNETT ST, SUITE 202, HENDERSON, NC 27536-4538
(252) 492-9205
(252) 492-9088
Mailing address
107 CURRIN LN, WARRENTON, NC 27589-2249
(252) 257-9349
(252) 492-9088
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL091077
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805648
—
NC
Enumeration date
01/26/2007
Last updated
08/22/2020
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