Organization
GUARDIAN RESIDENTIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FATMATA ALIE SANKOH (PROGRAM DIRECTOR)
(571) 263-5428
Entity
Organization
Contact information
Practice address
4800 MAURINE CT, GAINESVILLE, VA 20155-1204
(571) 263-5428
Mailing address
4800 MAURINE CT, GAINESVILLE, VA 20155-1204
(571) 263-5428
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
06/03/2019
Last updated
06/03/2019
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