Provider Demographics
NPI:1558476473
Name:GUARDIAN ANGEL HOME CARE SERVICES,LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME CARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:T
Authorized Official - Last Name:FITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-312-9990
Mailing Address - Street 1:1825 SAINT JULIAN PL
Mailing Address - Street 2:STE #G-6
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2424
Mailing Address - Country:US
Mailing Address - Phone:803-312-9990
Mailing Address - Fax:803-312-9990
Practice Address - Street 1:1825 SAINT JULIAN PL
Practice Address - Street 2:STE #G-6
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2424
Practice Address - Country:US
Practice Address - Phone:803-312-9990
Practice Address - Fax:803-312-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0787Medicaid