Provider Demographics
NPI:1467747634
Name:GUARDIAN ANGELS HOMECARE LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGELS HOMECARE LLC
Other - Org Name:HOME HELPERS DIRECT LINK # 58505
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:O'BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-485-8663
Mailing Address - Street 1:142 WILDER DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7267
Mailing Address - Country:US
Mailing Address - Phone:270-485-8663
Mailing Address - Fax:270-926-7021
Practice Address - Street 1:4400 WASHINGTON AVE # 303
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0887
Practice Address - Country:US
Practice Address - Phone:270-485-8663
Practice Address - Fax:270-926-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11-012572-1253Z00000X
KY500126253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care