Provider Demographics
NPI:1790353100
Name:HUMBLE GUARDIANS LLC,
Entity Type:Organization
Organization Name:HUMBLE GUARDIANS LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:WIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:610-568-5583
Mailing Address - Street 1:6504 CASTINE LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-4277
Mailing Address - Country:US
Mailing Address - Phone:610-568-5583
Mailing Address - Fax:
Practice Address - Street 1:6504 CASTINE LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-4277
Practice Address - Country:US
Practice Address - Phone:610-568-5583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-12
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care