BRENDA W BRYAN NPI 1376724039

NPI Information

NPI: 1376724039
Provider Name: BRENDA W BRYAN
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Doing Business As: MY GUARDIAN ANGEL GROUP HOME
Address: 2001 VERNON RD
ROCKY MOUNT, NC
ZIP 27801
Phone: (252) 977-1956

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NPI Details

BRENDA W BRYAN is a community based residential treatment facility, intellectual and/or developmental disabilities in Rocky Mount, NC. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. BRENDA W BRYAN NPI is 1376724039. The provider is registered as an organization entity type.
The provider Is Doing Business As My Guardian Angel Group Home.

The provider's business location address is:

2001 VERNON RD
ROCKY MOUNT, NC
ZIP 27801
Phone: (252) 977-1956
Fax: (252) 977-1956

The provider's authorized official is Brenda Bryant .
The authorized official title is Owner and has the following contact phone number (252) 977-1956.

The enumeration date for this NPI number is 11/21/2007 and was last updated on 8/1/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320600000X	Residential Treatment Facility, Intellectual and/or Developmental Disabilities		MHL033046	NORTH CAROLINA	No
2	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		MHL033046	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7805933	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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