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General NPI Number Information
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NPI Number | 1003010166
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Entity Type | Organization
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Legal Business Name | GUARDIAN LIVING SERVICES INC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 11970 WILCREST DR. SUITE 102
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City | HOUSTON
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State | TX
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Zip | 77031
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Country | US
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Telephone | 281-530-6780
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Fax | 281-530-8188
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Provider Business Mailing Address
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Address Line | PO BOX 769
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City | FRESNO
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State | TX
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Zip | 77545-0769
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Country | US
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Telephone | 281-530-6780
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Fax | 281-530-8188
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. CHRISTINA ETUK KIZZEE
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Credential |
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Telephone | 281-530-6780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001007885
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001007886
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001007887
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001010519
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001007700
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License Number State | TX
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