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General NPI Number Information
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NPI Number | 1174707640
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Entity Type | Organization
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Legal Business Name | GUARDIAN HOME II ALF LLC
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 902 CANAL ST.
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168
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Country | US
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Telephone | 386-409-9455
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Fax | 386-409-9456
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Provider Business Mailing Address
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Address Line | 431 EAST AIRPORT BLVD.
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City | SANFORD
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State | FL
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Zip | 32773-5494
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Country | US
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Telephone | 407-323-2545
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Fax | 407-323-2545
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. GLADYS FERNANDO
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Credential | RN
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Telephone | 386-409-9456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL55
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License Number State | FL
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