Provider Demographics
NPI:1841776796
Name:GUARDIAN ANGEL SUPPORT COORDINATION AGENCY, LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL SUPPORT COORDINATION AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEYAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KESSELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MSAC
Authorized Official - Phone:215-704-1606
Mailing Address - Street 1:1528 WALTERS AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-2527
Mailing Address - Country:US
Mailing Address - Phone:215-704-1606
Mailing Address - Fax:
Practice Address - Street 1:1528 WALTERS AVE
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-2527
Practice Address - Country:US
Practice Address - Phone:215-704-1606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health