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General NPI Number Information
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NPI Number | 1528269859
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGEL PERSONAL CARE HOME
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5734 BELCREST ST
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City | HOUSTON
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State | TX
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Zip | 77033-2140
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Country | US
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Telephone | 713-731-8569
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Fax |
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Provider Business Mailing Address
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Address Line | 5734 BELCREST ST
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City | HOUSTON
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State | TX
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Zip | 77033-2140
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. IMOGENE GUNTER
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Credential | R.N.
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Telephone | 281-989-8646
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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 | 030005
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License Number State | TX
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