Provider Demographics
NPI:1427386291
Name:GUARDIAN ANGEL PERSONAL SERVICES, INC.
Entity Type:Organization
Organization Name:GUARDIAN ANGEL PERSONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HADLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:812-735-2811
Mailing Address - Street 1:11617 E STATE ROAD 67
Mailing Address - Street 2:P.O. BOX 196
Mailing Address - City:BICKNELL
Mailing Address - State:IN
Mailing Address - Zip Code:47512-8232
Mailing Address - Country:US
Mailing Address - Phone:812-735-2811
Mailing Address - Fax:812-735-2332
Practice Address - Street 1:11617 E STATE ROAD 67
Practice Address - Street 2:
Practice Address - City:BICKNELL
Practice Address - State:IN
Practice Address - Zip Code:47512-8232
Practice Address - Country:US
Practice Address - Phone:812-735-2811
Practice Address - Fax:812-735-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09-012231-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN09-012231-1OtherINDIANA STATE DEPARTMENT OF HEALTH