Provider Demographics
NPI:1912278987
Name:GUARDIAN ANGELS HOMECARE, LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGELS HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-204-3800
Mailing Address - Street 1:1335 OLD CAPE RD.
Mailing Address - Street 2:SUITE F
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755
Mailing Address - Country:US
Mailing Address - Phone:573-204-3800
Mailing Address - Fax:573-204-3888
Practice Address - Street 1:1335 OLD CAPE RD.
Practice Address - Street 2:SUITE F
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755
Practice Address - Country:US
Practice Address - Phone:573-204-3800
Practice Address - Fax:573-204-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251J00000X, 253Z00000X, 343900000X, 347C00000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle