Provider Demographics
NPI:1871043752
Name:GUARDIAN ANGEL HOME HEALTH, INC.
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME HEALTH, INC.
Other - Org Name:GUARDIAN ANGEL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-564-9002
Mailing Address - Street 1:PO BOX 3590
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-3590
Mailing Address - Country:US
Mailing Address - Phone:505-564-9002
Mailing Address - Fax:505-564-9022
Practice Address - Street 1:2800 HUTTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-4560
Practice Address - Country:US
Practice Address - Phone:505-564-9002
Practice Address - Fax:505-564-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3132251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51629861Medicaid
NM51629861Medicaid