Healthcare Provider Details

I. General information

NPI: 1851506554
Provider Name (Legal Business Name): GUARDIAN ANGELS CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MORGAN ST
BALL LA
71405-3306
US

IV. Provider business mailing address

104 MORGAN ST
BALL LA
71405-3306
US

V. Phone/Fax

Practice location:
  • Phone: 318-641-6122
  • Fax: 318-641-6128
Mailing address:
  • Phone: 318-641-6122
  • Fax: 318-641-6128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1430781
License Number StateLA

VIII. Authorized Official

Name: MARLON MONROE CAUSEY
Title or Position: DIRECTOR OF QUALITY
Credential:
Phone: 318-641-6122