Provider Demographics
NPI:1003010166
Name:GUARDIAN LIVING SERVICES INC
Entity type:Organization
Organization Name:GUARDIAN LIVING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ETUK
Authorized Official - Last Name:KIZZEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-530-6780
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-0769
Mailing Address - Country:US
Mailing Address - Phone:281-530-6780
Mailing Address - Fax:281-530-8188
Practice Address - Street 1:11970 WILCREST DR.
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031
Practice Address - Country:US
Practice Address - Phone:281-530-6780
Practice Address - Fax:281-530-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001007885320900000X
TX001007886320900000X
TX001007887320900000X
TX001010519320900000X
TX001007700320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities