Provider Demographics
NPI:1043055510
Name:GUARDIAN MANOR LLC
Entity type:Organization
Organization Name:GUARDIAN MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIZAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-229-0754
Mailing Address - Street 1:23105 53RD AVE W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4703
Mailing Address - Country:US
Mailing Address - Phone:206-229-0754
Mailing Address - Fax:
Practice Address - Street 1:23105 53RD AVE W
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4703
Practice Address - Country:US
Practice Address - Phone:206-229-0754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home