Provider Demographics
NPI:1689045254
Name:GUARDIAN ANGELS GROUP HOME LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGELS GROUP HOME LLC
Other - Org Name:1 GUARDIAN ANGELS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:N
Authorized Official - Last Name:KARIUKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-401-7301
Mailing Address - Street 1:426 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5526
Mailing Address - Country:US
Mailing Address - Phone:469-401-7301
Mailing Address - Fax:
Practice Address - Street 1:426 BIRCH LN
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5526
Practice Address - Country:US
Practice Address - Phone:469-401-7301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3747A0650XMedicare Oscar/Certification
TX3747P1801XMedicare Oscar/Certification