MEDICARE: GUARDIAN ANGEL CONCIERGE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	343900000X	Non-emergency Medical Transport (VAN)
3	385H00000X	Respite Care
4	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1437781887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN ANGEL CONCIERGE SERVICES LLC

Provider Business Mailing Address
First Line	:	156 COLRAIN STAGE RD
Second Line	:
City	:	COLRAIN
State	:	MA
Zip	:	01340-9506
Country	:	US
Telephone Number	:	802-440-6958
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 COLRAIN STAGE RD
Second Line	:
City	:	HEATH
State	:	MA
Zip	:	01346
Country	:	US
Telephone Number	:	413-337-5377
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. BRIAN ALFRED DONELSON
Credential	:
Telephone Number	:	802-753-7112

Provider Enumeration Date	:	02/04/2020
Last Update Date	:	02/04/2020

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