Provider Demographics
NPI:1093253692
Name:GUARDIAN ANGELS FOR SENIORS
Entity Type:Organization
Organization Name:GUARDIAN ANGELS FOR SENIORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MUKOSOLU
Authorized Official - Middle Name:
Authorized Official - Last Name:EGWIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-763-0459
Mailing Address - Street 1:2555 NE LOOP 410
Mailing Address - Street 2:#2302
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5717
Mailing Address - Country:US
Mailing Address - Phone:210-763-0459
Mailing Address - Fax:
Practice Address - Street 1:2555 NE LOOP 410
Practice Address - Street 2:#2302
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5717
Practice Address - Country:US
Practice Address - Phone:210-763-0459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health