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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |