Organization
THE GUARDIAN LIGHT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANICE MARIE BAILEY M.S. (ADMINISTRATOR)
(804) 475-3344
Entity
Organization
Contact information
Practice address
2101 MOUNTAIN RUN DR, GLEN ALLEN, VA 23060-2261
(804) 475-3344
Mailing address
2101 MOUNTAIN RUN DR, GLEN ALLEN, VA 23060-2261
(804) 475-3344
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
CLO-08-1104074
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CL0-08-1104074
LICENSE FROM DEPARTMENT OF SOCIAL SERVICES
VA
01
—
CLO-081104074
LICENSE FROM DEPARTMENT OF SOCIAL SERVICES
VA
Enumeration date
07/17/2008
Last updated
07/17/2008
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