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General NPI Number Information
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NPI Number | 1396149712
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGEL COMMUNITY SERVICES
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 168 N OTTAWA ST
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City | JOLIET
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State | IL
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Zip | 60432-4142
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Country | US
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Telephone | 815-729-0930
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Fax | 815-744-6087
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Provider Business Mailing Address
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Address Line | 168 N OTTAWA ST
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City | JOLIET
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State | IL
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Zip | 60432-4142
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Country | US
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Telephone | 815-729-0930
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Fax | 815-744-6087
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | INES KUTLESA
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Credential | LCPC
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Telephone | 815-729-0930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 032673-12
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License Number State | IL
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