# GUARDIAN ANGELS INDEPENDENT LIVING SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053593574
- **Authorized official:** JOHNNY BOB ROSS SR. (OWNER)
- **Authorized official phone:** (225) 922-4466

## Contact information

- **Practice address:** 1821 WOODDALE CT, SUITE 104, BATON ROUGE, LA 70806-1535
- **Practice address phone:** (225) 922-4466
- **Practice address fax:** (225) 922-4420
- **Mailing address:** 1821 WOODDALE CT, SUITE 104, BATON ROUGE, LA 70806-1535
- **Mailing address phone:** (225) 922-4466
- **Mailing address fax:** (225) 922-4420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | 14010 | LA | Yes |

## Other

- **Enumeration date:** 11/27/2007
- **Last updated:** 11/27/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1019950 | — | LA |