Provider Demographics
NPI:1508058660
Name:GUARDIAN ANGEL RCF
Entity Type:Organization
Organization Name:GUARDIAN ANGEL RCF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RALENE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:816-313-2515
Mailing Address - Street 1:6112 MANNING AVE
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3757
Mailing Address - Country:US
Mailing Address - Phone:816-313-2515
Mailing Address - Fax:816-313-9935
Practice Address - Street 1:6112 MANNING AVE
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3757
Practice Address - Country:US
Practice Address - Phone:816-313-2515
Practice Address - Fax:816-313-9935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033926310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility