Provider Demographics
NPI:1609312305
Name:GUARDIAN ANGEL HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAMAU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-316-7421
Mailing Address - Street 1:5600 KENNY DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9396
Mailing Address - Country:US
Mailing Address - Phone:614-316-7421
Mailing Address - Fax:
Practice Address - Street 1:5969 E LIVINGSTON AVE STE 112
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2907
Practice Address - Country:US
Practice Address - Phone:614-868-3225
Practice Address - Fax:614-868-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health