Provider Demographics
NPI:1770149411
Name:GUARDIAN ANGEL CAREGIVERS LLC
Entity type:Organization
Organization Name:GUARDIAN ANGEL CAREGIVERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:503-698-2020
Mailing Address - Street 1:PO BOX 33726
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-3726
Mailing Address - Country:US
Mailing Address - Phone:503-698-2020
Mailing Address - Fax:503-926-9303
Practice Address - Street 1:11022 SE LENORE ST
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-8790
Practice Address - Country:US
Practice Address - Phone:503-698-2020
Practice Address - Fax:503-926-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15-2251OtherSTATE LICENSE