Provider Demographics
NPI:1649660317
Name:GUARDIAN ANGEL HOME HEALTHCARE
Entity type:Organization
Organization Name:GUARDIAN ANGEL HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BODUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-866-5365
Mailing Address - Street 1:10000 N 31ST AVE
Mailing Address - Street 2:B111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9582
Mailing Address - Country:US
Mailing Address - Phone:602-866-5365
Mailing Address - Fax:
Practice Address - Street 1:10000 N 31ST AVE
Practice Address - Street 2:B111
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9582
Practice Address - Country:US
Practice Address - Phone:602-866-5365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF-1291518-5251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health