Provider Demographics
NPI:1407916117
Name:GUARDIAN ANGELS HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:GUARDIAN ANGELS HOME HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHAVIS
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-753-3500
Mailing Address - Street 1:3637 S GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-1897
Mailing Address - Country:US
Mailing Address - Phone:252-753-3500
Mailing Address - Fax:
Practice Address - Street 1:3637 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-1897
Practice Address - Country:US
Practice Address - Phone:252-753-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601247Medicaid