Healthcare Provider Details

I. General information

NPI: 1346668753
Provider Name (Legal Business Name): GUARDIAN HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5559 TROOPER ST
LAS VEGAS NV
89120-2232
US

IV. Provider business mailing address

5559 TROOPER ST
LAS VEGAS NV
89120-2232
US

V. Phone/Fax

Practice location:
  • Phone: 702-416-0307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number7543AGC-3
License Number StateNV

VIII. Authorized Official

Name: JOANNA ARMENTA-PEREZ
Title or Position: OWNER
Credential:
Phone: 702-416-0307