Provider Demographics
NPI:1114560364
Name:GUARDIAN ANGEL CARE MIHP
Entity Type:Organization
Organization Name:GUARDIAN ANGEL CARE MIHP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONJIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-858-7709
Mailing Address - Street 1:30169 JAMESTOWN ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-3149
Mailing Address - Country:US
Mailing Address - Phone:734-858-7709
Mailing Address - Fax:734-858-7802
Practice Address - Street 1:4609 S WAYNE RD STE 1
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2310
Practice Address - Country:US
Practice Address - Phone:734-858-7709
Practice Address - Fax:734-858-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251K00000XAgenciesPublic Health or Welfare