Healthcare Provider Details

I. General information

NPI: 1801526918
Provider Name (Legal Business Name): GUARDIAN ANGELS HOME CARE AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 E SOUTH BLVD STE L
MONTGOMERY AL
36116-2547
US

IV. Provider business mailing address

2424 E SOUTH BLVD STE L
MONTGOMERY AL
36116-2547
US

V. Phone/Fax

Practice location:
  • Phone: 910-734-1449
  • Fax: 678-401-0228
Mailing address:
  • Phone: 910-734-1449
  • Fax: 678-401-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: THOMAS JONES
Title or Position: PRESIDENT
Credential:
Phone: 334-221-3821