Provider Demographics
NPI:1255866950
Name:GUARDIAN OF ANGELS COMMUNITY LIVING
Entity Type:Organization
Organization Name:GUARDIAN OF ANGELS COMMUNITY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-406-2822
Mailing Address - Street 1:12703 JONES RD
Mailing Address - Street 2:1115
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070
Mailing Address - Country:US
Mailing Address - Phone:832-406-2822
Mailing Address - Fax:
Practice Address - Street 1:12703 JONES RD
Practice Address - Street 2:1115
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4676
Practice Address - Country:US
Practice Address - Phone:832-406-2822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization