Provider Demographics
NPI:1275703779
Name:GUARDIAN ANGEL CARE CENTER
Entity Type:Organization
Organization Name:GUARDIAN ANGEL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:JULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-576-3530
Mailing Address - Street 1:206 NW 98TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-7573
Mailing Address - Country:US
Mailing Address - Phone:360-576-3530
Mailing Address - Fax:
Practice Address - Street 1:206 NW 98TH CIR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-7573
Practice Address - Country:US
Practice Address - Phone:360-576-3530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA489102311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA311ZA0620XOtherADULT CARE HOME