Suburban Guardianship, LLC.

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

SUBURBAN GUARDIANSHIP, LLC.

Practice address

1061 Union St S
Concord, NC 28025-5778

Phone

(704) 918-4627

Fax

(704) 918-4627

NPI assigned

Jul 31, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Deshaun Vrain Clark

Title

Owner/Ceo

Phone

(704) 918-4627

Specialties & licenses 1

Addresses

Other names 1

• Suburban Guardianship, LLC. Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501459200000",
    "number": "1336663442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 UNION ST S",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280255778",
            "telephone_number": "704-918-4627",
            "fax_number": "704-918-4627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 UNION ST S",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280255778",
            "telephone_number": "704-918-4627",
            "fax_number": "704-918-4627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBURBAN GUARDIANSHIP, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-31",
        "last_updated": "2017-07-31",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DESHAUN",
        "authorized_official_middle_name": "VRAIN",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "704-918-4627",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suburban Guardianship, LLC.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Roxanne Kathleen Stroud, NP
• Kayley Rebecca Strum, OT
• Stsdavisllc
• Ashley Stuart
• Lakale Tayforia Sturdivant, MA, LPC
• Jesse Sulzer, MD
• Lisa Ann Summers, MD
• Sierra Lyn Summerville
• William T Sumner, MD
• Devina Mohan Sundaresan, M.D.

• Adult Care Home Facility in Concord, NC
• Providers in Concord, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.