Provider Demographics
NPI:1174820765
Name:GUARDIAN ANGEL HEALTHCARE INC., II
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HEALTHCARE INC., II
Other - Org Name:PATIENTS CHOICE CLINIC OF RALEIGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-782-9997
Mailing Address - Street 1:347 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:MS
Mailing Address - Zip Code:39153-6011
Mailing Address - Country:US
Mailing Address - Phone:601-782-9997
Mailing Address - Fax:
Practice Address - Street 1:347 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:MS
Practice Address - Zip Code:39153-6011
Practice Address - Country:US
Practice Address - Phone:601-782-9997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health