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GUARDIAN MANOR LLC
NPI 1043055510
Custodial Care Facility - Adult Care Home in Mountlake Terrace, WA

Active since June 27, 2024CLIA 50D2341135 · Waiver
23105 53RD AVE W, MOUNTLAKE TERRACE, WA 98043(206) 229-0754 Get Directions Write a Review

NPPES record last updated: June 27, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Guardian Manor Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GUARDIAN MANOR LLC (NPI 1043055510) is a healthcare organization registered as an adult care home in Mountlake Terrace, Washington and active in the NPI registry since June 2024. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Hanna Gizaw, Provider, as its authorized official.

NPPES Registry Identity

NPI1043055510
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NameGUARDIAN MANOR LLC
Location Address23105 53RD AVE WMountlake Terrace, WA 98043-4703
Mailing Address23105 53rd Ave WMountlake Terrace, WA 98043-4703 · (206) 229-0754
Phone(206) 229-0754
Organization SubpartNo
Authorized OfficialHanna GizawProvider · (206) 229-0754
Enumeration DateJune 27, 2024
NPPES CertifiedJune 27, 2024
✔ NPI 1043055510 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities
Taxonomy Code311ZA0620X
Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
23105 53RD AVE W, Mountlake Terrace, WA 98043
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2341135

Guardian Manor LLC · Mountlake Terrace, WA
Active · expires Apr 4, 2028
CLIA Number50D2341135
Laboratory TypeAfh
Certificate Effective DateMarch 27, 2026
Certificate Expiration DateApril 4, 2028
Laboratory DirectorHanna Gizaw
Laboratory Phone(425) 697-2444
Laboratory LocationGuardian Manor LLC23105 53rd Ave W, Mountlake Terrace, WA 98043
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Guardian Manor LLC's NPI number?

The NPI number for Guardian Manor LLC is 1043055510. It was assigned to this organization in the NPPES registry on June 27, 2024.

Where is Guardian Manor LLC located?

Guardian Manor LLC is located at 23105 53rd Ave W, Mountlake Terrace, WA 98043. The listed phone number is (206) 229-0754.

What is Guardian Manor LLC's specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

Does Guardian Manor LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D2341135) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Guardian Manor LLC was last updated on June 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.