Healthcare Provider Details

I. General information

NPI: 1033472493
Provider Name (Legal Business Name): GUARDIAN ANGELS HOME CARE AND STAFFING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 S BEND DR
CORDOVA TN
38016-5451
US

IV. Provider business mailing address

1991 S BEND DR
CORDOVA TN
38016-5451
US

V. Phone/Fax

Practice location:
  • Phone: 901-485-1487
  • Fax:
Mailing address:
  • Phone: 901-485-1487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. SHARONDA JEANAE ROBINSON
Title or Position: CHEIF ADMINISTRATOR
Credential: M.S
Phone: 901-485-1487