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General NPI Number Information
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NPI Number | 1194134106
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGELS GROUP HOME LLC
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 426 BIRCH LN
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City | RICHARDSON
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State | TX
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Zip | 75081-5526
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Country | US
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Telephone | 469-401-7301
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Fax | 972-234-4041
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Provider Business Mailing Address
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Address Line | 426 BIRCH LN
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City | RICHARDSON
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State | TX
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Zip | 75081-5526
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Country | US
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Telephone | 469-401-7301
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Fax | 972-234-4041
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOSHUA KARIUKI
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Credential |
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Telephone | 469-401-7301
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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 | 139074
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 103113
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License Number State | TX
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