Provider Demographics
NPI:1841565348
Name:GUARDIAN ANGELS ADULT LIVING LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGELS ADULT LIVING LLC
Other - Org Name:GUARDIAN ANGELS ADULT LIVING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JASUNDAR
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-753-5562
Mailing Address - Street 1:7828 WESTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3342
Mailing Address - Country:US
Mailing Address - Phone:313-753-5562
Mailing Address - Fax:313-563-3537
Practice Address - Street 1:7828 WESTWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3342
Practice Address - Country:US
Practice Address - Phone:313-753-5562
Practice Address - Fax:313-563-3537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home