Organization
GUARDIAN ANGEL HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REYNALDO S PATINO (ADMINISTRATIVE MANAGER)
(517) 914-1039
Entity
Organization
Contact information
Practice address
1038 WOODBRIDGE ST, JACKSON, MI 49203-3112
(517) 914-1039
Mailing address
725 N DETTMAN RD, JACKSON, MI 49202-2605
(517) 914-1039
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
AS380389381
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
AS380389381
MI
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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