MEDICARE: THE ANGELS GARDEN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	15AL0350	MD

General Provider Information

NPI Number	:	1730348665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ANGELS GARDEN LLC

Provider Business Mailing Address
First Line	:	4101 BEL PRE RD
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20853-2002
Country	:	US
Telephone Number	:	301-460-0304
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 BEL PRE RD
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20853-2002
Country	:	US
Telephone Number	:	301-460-0304
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. TANIE ANTOINE GUIRAND
Credential	:
Telephone Number	:	301-806-0151

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/13/2008

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