Organization
GUARDIAN ANGELS SUPPORTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE HARDAWAY LPN (CEO)
(573) 575-1015
Entity
Organization
Contact information
Practice address
1006 LINN ST, SIKESTON, MO 63801-2223
(573) 471-1412
(573) 481-4432
Mailing address
1006 LINN ST, SIKESTON, MO 63801-2223
(573) 471-1412
(573) 481-4432
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/17/2018
Last updated
05/01/2019
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