Provider Demographics
NPI:1205529633
Name:GUARDIAN ANGEL FAMILY SERVICES
Entity type:Organization
Organization Name:GUARDIAN ANGEL FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:BHT II
Authorized Official - Phone:888-973-2090
Mailing Address - Street 1:15214 N CAVE CREEK RD STE A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4360
Mailing Address - Country:US
Mailing Address - Phone:888-973-2090
Mailing Address - Fax:602-581-3263
Practice Address - Street 1:15214 N CAVE CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4360
Practice Address - Country:US
Practice Address - Phone:888-973-2090
Practice Address - Fax:602-581-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty