Organization
GUARDIAN ANGEL HEALTHCARE
Active
Other names
Willow Road Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORNELIUS WILLIAMS (PRESIDENT REGISTERED AGENT)
(252) 204-1381
Entity
Organization
Contact information
Practice address
474 MACON EMBRO RD, MACON, NC 27551-9285
(252) 257-1380
Mailing address
PO BOX 2002, HENDERSON, NC 27536-2002
(252) 204-1381
(252) 598-0051
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL093034
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804755
—
NC
Enumeration date
01/06/2007
Last updated
09/25/2021
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