Healthcare Provider Details

I. General information

NPI: 1588742712
Provider Name (Legal Business Name): GUARDIAN ANGEL HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 HUTTON AVE
FARMINGTON NM
87402-4560
US

IV. Provider business mailing address

PO BOX 3590
FARMINGTON NM
87499-3590
US

V. Phone/Fax

Practice location:
  • Phone: 505-564-9002
  • Fax: 505-564-9022
Mailing address:
  • Phone: 505-564-9002
  • Fax: 505-564-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3132
License Number StateNM

VIII. Authorized Official

Name: MRS. DIXIE LEIGH THOMPSON
Title or Position: OWNER/ADMINISTATOR
Credential: RN
Phone: 505-564-9002