Provider Demographics
NPI:1710333273
Name:GUARDIAN ANGELS HOME SERVICES
Entity Type:Organization
Organization Name:GUARDIAN ANGELS HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-718-5488
Mailing Address - Street 1:50 BRENNER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-1122
Mailing Address - Country:US
Mailing Address - Phone:937-718-5488
Mailing Address - Fax:937-258-3100
Practice Address - Street 1:50 BRENNER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-1122
Practice Address - Country:US
Practice Address - Phone:937-718-5488
Practice Address - Fax:937-258-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH400784130708OtherSTATE TESTED NURSE AIDE
OH0115965Medicaid