Organization
GUARDIAN ANGEL HEALTHCARE,LLC
Active
Other names
Charles Street Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORNELIUS WILLIAMS (PRESIDENTREGISTERED AGENT)
(252) 257-9349
Entity
Organization
Contact information
Practice address
270 CHARLES ST, HENDERSON, NC 27536-4328
(252) 492-1152
Mailing address
107 CURRIN LN, WARRENTON, NC 27589-2249
(252) 257-9349
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL091065
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603653
—
NC
Enumeration date
01/06/2007
Last updated
08/22/2020
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