Healthcare Provider Details

I. General information

NPI: 1376407072
Provider Name (Legal Business Name): GUARDIAN ANGEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 126TH AVE NW
COON RAPIDS MN
55448-1547
US

IV. Provider business mailing address

147 126TH AVE NW
COON RAPIDS MN
55448-1547
US

V. Phone/Fax

Practice location:
  • Phone: 763-229-1841
  • Fax:
Mailing address:
  • Phone: 763-229-1841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KENNETH NWACHI
Title or Position: OWNER
Credential:
Phone: 612-394-3302