Organization · NPI-2

Guardian Angel Homes LLC

Custodial Care Facility, Adult Care Home · Racine, WI

NPI number1710648100
StatusActive
Last updated in NPPESJan 7, 2022

Details

NPI
1710648100
Entity type
Organization (NPI-2)
Legal business name
Guardian Angel Homes LLC
Organization subpart
No
Enumeration date
Jan 7, 2022
Certification date
Jan 7, 2022
Last updated
Jan 7, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
311ZA0620X Custodial Care Facility, Adult Care Home––Yes

Practice location

815 8th St Apt M08
Racine, WI 53403-1491

Phone 262-883-7817

Mailing address

815 8th St Apt M08
Racine, WI 53403-1491

Phone 262-883-7817

Authorized official

Tasha Willis
Owner
2628837817

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