Provider Demographics
NPI:1184816894
Name:GUARDIAN ANGEL NURSING SERVICES, INC.
Entity Type:Organization
Organization Name:GUARDIAN ANGEL NURSING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BOLAJOKO
Authorized Official - Middle Name:
Authorized Official - Last Name:OTUKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-271-0997
Mailing Address - Street 1:9674 HALSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1882
Mailing Address - Country:US
Mailing Address - Phone:240-271-0997
Mailing Address - Fax:
Practice Address - Street 1:9674 HALSTEAD AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1882
Practice Address - Country:US
Practice Address - Phone:240-271-0997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2532251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health