Provider Demographics
NPI:1659874626
Name:HEAVENLY GUARDIANS HOMECARE
Entity Type:Organization
Organization Name:HEAVENLY GUARDIANS HOMECARE
Other - Org Name:HEAVENLY GUARDIANS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ-M
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-793-6052
Mailing Address - Street 1:966 E TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE CLOUD
Mailing Address - State:MI
Mailing Address - Zip Code:49349-9571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:966 E TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-9571
Practice Address - Country:US
Practice Address - Phone:231-793-6052
Practice Address - Fax:231-793-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health