Organization
BRENDA W BRYAN
Active
Other names
My Guardian Angel Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA BRYANT (OWNER)
(252) 977-1956
Entity
Organization
Contact information
Practice address
2001 VERNON RD, ROCKY MOUNT, NC 27801
(252) 977-1956
(252) 977-1956
Mailing address
2001 VERNON RD, ROCKY MOUNT, NC 27801
(252) 977-1956
(252) 977-1956
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL033046
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL033046
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805933
—
NC
Enumeration date
11/21/2007
Last updated
08/01/2008
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