Provider Demographics
NPI:1295308484
Name:GUARDIAN ANGEL HEALTHCARE, LLC
Entity type:Organization
Organization Name:GUARDIAN ANGEL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:252-572-4005
Mailing Address - Street 1:PO BOX 2002
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2002
Mailing Address - Country:US
Mailing Address - Phone:252-572-4005
Mailing Address - Fax:252-598-0051
Practice Address - Street 1:119 BYNUM PL
Practice Address - Street 2:
Practice Address - City:NORLINA
Practice Address - State:NC
Practice Address - Zip Code:27563-9139
Practice Address - Country:US
Practice Address - Phone:252-204-1381
Practice Address - Fax:252-598-0051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUARDIAN ANGEL HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health