Guardian Residential Services LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

GUARDIAN RESIDENTIAL SERVICES LLC

Practice address

4800 Maurine CT
Gainesville, VA 20155-1204

Phone

(571) 263-5428

NPI assigned

Jun 3, 2019

Organization subpart

No

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

Authorized official

Name

Fatmata Alie SankohNPI 1609439264

Title

Program Director

Phone

(571) 263-5428

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fatmata Alie Sankoh

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Gainesville, VA
  • NPI 1609439264

  Residential Treatment Facility, Intellectual and/Or Developmental Disabilities

  NPD (past) Authorized official

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

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559520000000",
    "number": "1740848845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 MAURINE CT",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201551204",
            "telephone_number": "571-263-5428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 MAURINE CT",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201551204",
            "telephone_number": "571-263-5428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN RESIDENTIAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-03",
        "last_updated": "2019-06-03",
        "status": "A",
        "authorized_official_last_name": "SANKOH",
        "authorized_official_first_name": "FATMATA",
        "authorized_official_middle_name": "ALIE",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "571-263-5428"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Gainesville, VA
• Providers in Gainesville, VA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2019; 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.