Provider Demographics
NPI:1053451294
Name:GUARDIAN ANGEL HOME CARE, INC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HYACINTH
Authorized Official - Middle Name:EDWINA
Authorized Official - Last Name:REECE-HEADLEH
Authorized Official - Suffix:
Authorized Official - Credentials:MSM
Authorized Official - Phone:919-231-8683
Mailing Address - Street 1:2201 WOODWYCK WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-6128
Mailing Address - Country:US
Mailing Address - Phone:919-231-8683
Mailing Address - Fax:919-231-0226
Practice Address - Street 1:2201 WOODWYCK WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-6128
Practice Address - Country:US
Practice Address - Phone:919-231-8683
Practice Address - Fax:919-231-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children