Provider Demographics
NPI:1376101931
Name:GUARDIAN ANGEL HOME CARE AGENCY
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ZENETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:215-476-1939
Mailing Address - Street 1:205 S 60TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3841
Mailing Address - Country:US
Mailing Address - Phone:215-476-1939
Mailing Address - Fax:215-476-3121
Practice Address - Street 1:205 S 60TH ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3841
Practice Address - Country:US
Practice Address - Phone:215-476-1939
Practice Address - Fax:215-476-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health