Provider Demographics
NPI:1801229018
Name:GUARDIAN ANGEL HOME HEALTH
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIYERE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTUYA
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:240-462-9940
Mailing Address - Street 1:211 N UNION ST
Mailing Address - Street 2:#100 OLD TOWN
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2657
Mailing Address - Country:US
Mailing Address - Phone:703-519-1255
Mailing Address - Fax:
Practice Address - Street 1:211 N UNION ST
Practice Address - Street 2:#100 OLD TOWN
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2657
Practice Address - Country:US
Practice Address - Phone:703-519-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4626066468251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health