Healthcare Provider Details

I. General information

NPI: 1730496340
Provider Name (Legal Business Name): GUARDIAN ANGELS PRIVATE HOMECARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 DELAWARE ST SE
GRAND RAPIDS MI
49507-1230
US

IV. Provider business mailing address

634 DELAWARE ST SE
GRAND RAPIDS MI
49507-1230
US

V. Phone/Fax

Practice location:
  • Phone: 646-520-5739
  • Fax: 616-588-9733
Mailing address:
  • Phone: 646-520-5739
  • Fax: 616-588-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PAULA LORRAINE HESTER
Title or Position: CEO/ ADMINISTRATOR
Credential:
Phone: 646-520-5739