Provider Demographics
NPI:1104791920
Name:GUARDIAN ANGEL PERSONAL CARE SERVICE LLC
Entity type:Organization
Organization Name:GUARDIAN ANGEL PERSONAL CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEQUILA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:904-782-7315
Mailing Address - Street 1:22748 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTEY
Mailing Address - State:FL
Mailing Address - Zip Code:32058-4307
Mailing Address - Country:US
Mailing Address - Phone:904-782-7315
Mailing Address - Fax:
Practice Address - Street 1:22748 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:LAWTEY
Practice Address - State:FL
Practice Address - Zip Code:32058-4307
Practice Address - Country:US
Practice Address - Phone:904-782-7315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUARDIAN ANGEL PERSONAL CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No342000000XTransportation ServicesTransportation Network Company