Provider Demographics
NPI:1437916541
Name:GUARDIAN ANGEL DAY SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL DAY SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ISAMEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:804-715-7575
Mailing Address - Street 1:10116 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:N DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-9028
Mailing Address - Country:US
Mailing Address - Phone:804-715-7575
Mailing Address - Fax:
Practice Address - Street 1:10116 DUNCAN RD
Practice Address - Street 2:
Practice Address - City:N DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-9028
Practice Address - Country:US
Practice Address - Phone:804-715-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health