Provider Demographics
NPI:1669984878
Name:GUARDING ANGELS HOME HEALTH LLC
Entity type:Organization
Organization Name:GUARDING ANGELS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MBENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-418-7777
Mailing Address - Street 1:2828 NW 57TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7070
Mailing Address - Country:US
Mailing Address - Phone:405-418-7777
Mailing Address - Fax:405-418-7777
Practice Address - Street 1:2828 NW 57TH ST STE 304
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7070
Practice Address - Country:US
Practice Address - Phone:405-418-7777
Practice Address - Fax:405-418-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health