Provider Demographics
NPI:1568626216
Name:GUARDIAN ANGEL HEALTHCARE II, INC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HEALTHCARE II, INC
Other - Org Name:PATIENTS' CHOICE MEDICAL CENTER
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:601-732-7384
Mailing Address - Street 1:41 S HALL RD
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:MS
Mailing Address - Zip Code:39117-8057
Mailing Address - Country:US
Mailing Address - Phone:601-732-8473
Mailing Address - Fax:
Practice Address - Street 1:347 MAGNOLIA DRIVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:MS
Practice Address - Zip Code:39153
Practice Address - Country:US
Practice Address - Phone:601-782-9997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUARDIAN ANGEL HEALTHCARE II, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-11
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16-255275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25-U163OtherSWING BED CMS CERTIFICATION NUMBER