Provider Demographics
NPI:1831583152
Name:ITS MY GUARDIAN ANGEL LLC
Entity type:Organization
Organization Name:ITS MY GUARDIAN ANGEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-334-2567
Mailing Address - Street 1:1721 E BELT LINE RD
Mailing Address - Street 2:UNIT 221
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1721 E BELT LINE RD
Practice Address - Street 2:UNIT 221
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-9611
Practice Address - Country:US
Practice Address - Phone:682-334-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35233953347C00000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No347C00000XTransportation ServicesPrivate Vehicle