Provider Demographics
NPI:1134367717
Name:GUARDIAN ANGEL HOME HEALTH, INC
Entity type:Organization
Organization Name:GUARDIAN ANGEL HOME HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
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:2009-02-04
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3291251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based