Provider Demographics
NPI:1013517747
Name:GUARDIAN ANGEL HOME HEALTH CARE AGENCY, LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HOME HEALTH CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-704-1606
Mailing Address - Street 1:30 PRESTBURY SQ STE 301
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-3235
Mailing Address - Country:US
Mailing Address - Phone:302-476-1281
Mailing Address - Fax:302-338-8194
Practice Address - Street 1:30 PRESTBURY SQ STE 301
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3235
Practice Address - Country:US
Practice Address - Phone:302-476-1281
Practice Address - Fax:302-338-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE004749861OtherHIGHMARK BCBS-DE
DE004678495OtherHIGHMARK BCBS-DE