Provider Demographics
NPI:1033894860
Name:GERTS GUARDIN ANGELS HOME CARE LLC
Entity Type:Organization
Organization Name:GERTS GUARDIN ANGELS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLISS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:835-208-0729
Mailing Address - Street 1:5139 LUDLOW ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3432
Mailing Address - Country:US
Mailing Address - Phone:610-570-0828
Mailing Address - Fax:
Practice Address - Street 1:1650 S WILTON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-5005
Practice Address - Country:US
Practice Address - Phone:835-208-0729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care