Provider Demographics
NPI:1861499204
Name:GUARDIAN ANGELS HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:GUARDIAN ANGELS HEALTH SERVICES, INC.
Other - Org Name:GUARDIAN ANGELS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-241-4439
Mailing Address - Street 1:400 EVANS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2604
Mailing Address - Country:US
Mailing Address - Phone:763-241-4400
Mailing Address - Fax:763-241-4444
Practice Address - Street 1:400 EVANS AVENUE
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2604
Practice Address - Country:US
Practice Address - Phone:763-241-4400
Practice Address - Fax:763-241-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00611314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN395040900Medicaid
245012Medicare Oscar/Certification