Provider Demographics
NPI:1336663442
Name:SUBURBAN GUARDIANSHIP, LLC.
Entity Type:Organization
Organization Name:SUBURBAN GUARDIANSHIP, LLC.
Other - Org Name:SUBURBAN GUARDIANSHIP, LLC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DESHAUN
Authorized Official - Middle Name:VRAIN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-918-4627
Mailing Address - Street 1:1061 UNION ST S
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5778
Mailing Address - Country:US
Mailing Address - Phone:704-918-4627
Mailing Address - Fax:704-918-4627
Practice Address - Street 1:1061 UNION ST S
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5778
Practice Address - Country:US
Practice Address - Phone:704-918-4627
Practice Address - Fax:704-918-4627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home