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General NPI Number Information
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NPI Number | 1952445090
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGEL FAMILY CARE HOME, INC
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 1006 RICHMOND AVE
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City | BURLINGTON
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State | NC
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Zip | 27217-1525
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Country | US
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Telephone | 336-222-0114
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Fax | 336-222-0114
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Provider Business Mailing Address
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Address Line | 1006 RICHMOND AVE
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City | BURLINGTON
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State | NC
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Zip | 27217-1525
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Country | US
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Telephone | 336-222-0114
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Fax | 336-222-0114
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. VANESSA G. PACKINGHAM
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Credential |
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Telephone | 336-222-0114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | FCL-001-118
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License Number State | NC
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