Provider Demographics
NPI:1194134106
Name:GUARDIAN ANGELS GROUP HOME LLC
Entity type:Organization
Organization Name:GUARDIAN ANGELS GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIUKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-401-7301
Mailing Address - Street 1:426 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5526
Mailing Address - Country:US
Mailing Address - Phone:469-401-7301
Mailing Address - Fax:972-234-4041
Practice Address - Street 1:426 BIRCH LN
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5526
Practice Address - Country:US
Practice Address - Phone:469-401-7301
Practice Address - Fax:972-234-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139074310400000X
TX103113311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility