Provider Demographics
NPI:1528269859
Name:GUARDIAN ANGEL PERSONAL CARE HOME
Entity type:Organization
Organization Name:GUARDIAN ANGEL PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IMOGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-989-8646
Mailing Address - Street 1:5734 BELCREST ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-2140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5734 BELCREST ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-2140
Practice Address - Country:US
Practice Address - Phone:713-731-8569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX030005310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility