Provider Demographics
NPI:1316178940
Name:GUARDIAN ASSISTED LIVING
Entity Type:Organization
Organization Name:GUARDIAN ASSISTED LIVING
Other - Org Name:OPERATED BY: T R ASSISTED LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BEUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-794-9569
Mailing Address - Street 1:99 CULBERTSON LANE
Mailing Address - Street 2:
Mailing Address - City:CASTLEWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24224
Mailing Address - Country:US
Mailing Address - Phone:276-794-9569
Mailing Address - Fax:276-794-9403
Practice Address - Street 1:99 CULBERTSON LANE
Practice Address - Street 2:
Practice Address - City:CASTLEWOOD
Practice Address - State:VA
Practice Address - Zip Code:24224
Practice Address - Country:US
Practice Address - Phone:276-794-9569
Practice Address - Fax:276-794-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAALF1104133311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home