Provider Demographics
NPI:1730496340
Name:GUARDIAN ANGELS PRIVATE HOMECARE CORP.
Entity Type:Organization
Organization Name:GUARDIAN ANGELS PRIVATE HOMECARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-520-5739
Mailing Address - Street 1:634 DELAWARE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-1230
Mailing Address - Country:US
Mailing Address - Phone:646-520-5739
Mailing Address - Fax:616-588-9733
Practice Address - Street 1:634 DELAWARE ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-1230
Practice Address - Country:US
Practice Address - Phone:646-520-5739
Practice Address - Fax:616-588-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health