Provider Demographics
NPI:1780270777
Name:GUARDIAN ANGEL HOME 4 LOVED ONES
Entity type:Organization
Organization Name:GUARDIAN ANGEL HOME 4 LOVED ONES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RN, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKEDI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:214-202-9640
Mailing Address - Street 1:12809 FLAT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3105
Mailing Address - Country:US
Mailing Address - Phone:214-202-9640
Mailing Address - Fax:713-340-1252
Practice Address - Street 1:12809 FLAT CREEK DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3105
Practice Address - Country:US
Practice Address - Phone:214-202-9640
Practice Address - Fax:713-340-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities