Provider Demographics
NPI:1699219279
Name:GUARDIAN ANGEL HEALTH CARE, INC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-752-4444
Mailing Address - Street 1:5822 S GRAND BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-2305
Mailing Address - Country:US
Mailing Address - Phone:314-685-5048
Mailing Address - Fax:
Practice Address - Street 1:5822 S GRAND BLVD FL 1
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-2305
Practice Address - Country:US
Practice Address - Phone:314-685-5048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health