Provider Demographics
NPI:1760630255
Name:GUARDIAN ANGEL HOME CARE AGENCY, INC.
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO (DIRECTOR)
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FUNDERBURK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-948-5654
Mailing Address - Street 1:7210 N LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4012
Mailing Address - Country:US
Mailing Address - Phone:704-948-5654
Mailing Address - Fax:704-563-1341
Practice Address - Street 1:7210 N LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-4012
Practice Address - Country:US
Practice Address - Phone:704-948-5654
Practice Address - Fax:704-563-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care