Provider Demographics
NPI:1396149712
Name:GUARDIAN ANGEL COMMUNITY SERVICES
Entity type:Organization
Organization Name:GUARDIAN ANGEL COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:INES
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTLESA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-729-0930
Mailing Address - Street 1:168 N OTTAWA ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-4142
Mailing Address - Country:US
Mailing Address - Phone:815-729-0930
Mailing Address - Fax:815-744-6087
Practice Address - Street 1:168 N OTTAWA ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-4142
Practice Address - Country:US
Practice Address - Phone:815-729-0930
Practice Address - Fax:815-744-6087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL032673-12253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency