GUARDIAN ANGEL HEALTHCARE (NPI# 1720136963) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720136963 |
| Entity Type | Organization |
| Organization Name | GUARDIAN ANGEL HEALTHCARE |
| Other Organization Name | WILLOW ROAD FACILITY |
| Practice Address |
474 Macon Embro Rd Macon NC 27551-9285 |
| Mailing Address |
107 Currin Ln Warrenton NC 27589-2249 |
| Practice Telephone | 2522571380 |
| Mailing Telephone | 2522579349 |
| Enumeration Date | 2007-01-06 |
| Last Update Date | 2008-02-04 |
| Authorized Official Name | MR. CORNELIUS WILLIAMS (PRESIDENT REGISTERED AGENT) |
| Authorized Official Telephone | 2522579343 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | MHL093034 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7804755 | 05 |
| Other Name | Type Code |
|---|---|
| Willow Road Facility | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376691519 | Guardian Angel Healthcare | Residential Treatment Facility, Emotionally Disturbed Children | 273 Gillburg Rd, Henderson, NC 27537-7555 | 2007-01-06 |
| Street Address |
474 MACON EMBRO RD |
| City | MACON |
| State | NC |
| Zip Code | 27551-9285 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730366089 | Willow Road Facility | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 474 Macon Embro Rd, Macon, NC 27551-9285 | 2008-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396184982 | Smith Landing 2 | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 196 Theo Robertson Road, Macon, NC 27551 | 2013-06-18 |
| 1407295116 | Cassie's Place | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 905 Oaksville Road, Macon, NC 27551 | 2013-06-17 |
| 1215129119 | Smith's Landing | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1508 Theo Robertson Rd., Macon, NC 27551 | 2007-08-14 |
| 1184165987 | Bridgette Boyd | Adult Companion | 106 Eaton Ferry Rd, Macon, NC 27551-9099 | 2017-03-13 |
| 1174092696 | Unconditional Care Senior Services | Adult Companion | 106 Eaton Ferry Rd, Macon, NC 27551-9099 | 2018-11-14 |
| 1699953497 | Jessie's Place | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 516 Macon Embro Rd, Macon, NC 27551-9287 | 2008-02-04 |
| 1962536672 | Boyd's Rest Home | Custodial Care Facility | 295 Carroll Town Rd, Macon, NC 27551-9292 | 2007-03-15 |
| 1376928846 | Aha Moment, Inc. | Home Health | 295 Carroll Town Rd, Macon, NC 27551-9292 | 2015-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376143941 | Wanda Welch | Spec/Tech, Health Info | 2720 Sheraton Dr Ste 170, Macon, GA 31204-6806 | 2020-10-31 |
| 1093315848 | Tracy Tarvers | Nurse Practitioner | 129 Wolf Creek Dr N, Macon, GA 31210-9002 | 2020-10-30 |
| 1346840451 | Emily Lauren Brooks | Registered Nurse | 104 Ellis Way, Macon, GA 31216-6278 | 2020-10-28 |
| 1538768296 | Ga Diagnostic Providers | Clinic/Center | 5400 Riverside Dr Ste 202, Macon, GA 31210-0818 | 2020-10-22 |
| 1134728447 | Daniela Morgan Ragins | Registered Nurse | 4287 Vinson Ave, Macon, GA 31206-4055 | 2020-10-19 |
| 1659979086 | Mvp Physio Dr. | Clinic/Center | 123 Umiya Nagar Cir, Macon, GA 31206-5401 | 2020-10-16 |
| 1225636392 | Courtney Hampton | Counselor | 1800 Wesleyan Dr Apt 95, Macon, GA 31210-1075 | 2020-10-12 |
| 1578160560 | Ida Mayaka | Nurse Practitioner | 210 Autumn Trace Ct, Macon, GA 31210-8025 | 2020-10-03 |
| 1821604158 | Tekeria Gallemore | Nurse Practitioner | 204 Rockingham Pl, Macon, GA 31217-2615 | 2020-09-22 |
| 1801402714 | Top Dog Solutions LLC | Otolaryngology | 4295 Interstate Dr Ste B, Macon, GA 31210-6815 | 2020-09-17 |
| Find all providers in MACON | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396184982 | Smith Landing 2 | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 196 Theo Robertson Road, Macon, NC 27551 | 2013-06-18 |
| 1407295116 | Cassie's Place | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 905 Oaksville Road, Macon, NC 27551 | 2013-06-17 |
| 1699953497 | Jessie's Place | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 516 Macon Embro Rd, Macon, NC 27551-9287 | 2008-02-04 |
| 1215129119 | Smith's Landing | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1508 Theo Robertson Rd., Macon, NC 27551 | 2007-08-14 |
| 1558732917 | Healing Hands Personal Care Home LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 870 E St, Macon, GA 31206-8338 | 2015-10-12 |
| 1730366089 | Willow Road Facility | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 474 Macon Embro Rd, Macon, NC 27551-9285 | 2008-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578160552 | Residential Option Serving Adolescents, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2316 Carved Tree Ln, Charlotte, NC 28262-3154 | 2020-10-03 |
| 1649895442 | Gaynelle Bolling | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 102 Mandarin Dr, Pikeville, NC 27863-0020 | 2020-06-08 |
| 1851913966 | Johnson Enrichment Services LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 221 Foxcroft Dr, Winston Salem, NC 27103-5313 | 2020-05-12 |
| 1881230795 | Walter Jason Young Jr. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 412 Rook Rd, Charlotte, NC 28216-3199 | 2019-11-26 |
| 1750935839 | Heavenly Touch Residential Care | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4720 Baileys Lake Rd Nw Apt 204, Concord, NC 28027-8576 | 2019-07-28 |
| 1073166245 | Making Kids Matter, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 409 Hunton Forest Dr Nw, Concord, NC 28027-0186 | 2019-07-17 |
| 1891357752 | New Hope for Tomorrow LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 528 Baldwin Rd, Burlington, NC 27217-1702 | 2019-07-01 |
| 1114490877 | Brenda Gail Cannon | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3105 Vico Ter, Raleigh, NC 27610-5951 | 2019-01-05 |
| 1356813455 | Lamesha Marshall | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3335 Avalon Ave, Charlotte, NC 28208-3378 | 2018-12-31 |
| 1487131074 | Ronald Anthony Benjamin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1594 Candace Ridge Dr, Greensboro, NC 27406-8595 | 2018-07-26 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on GUARDIAN ANGEL HEALTHCARE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.