Healthcare Provider Details

I. General information

NPI: 1790353100
Provider Name (Legal Business Name): HUMBLE GUARDIANS LLC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6504 CASTINE LN
SPRINGFIELD VA
22150-4277
US

IV. Provider business mailing address

6504 CASTINE LN
SPRINGFIELD VA
22150-4277
US

V. Phone/Fax

Practice location:
  • Phone: 610-568-5583
  • Fax:
Mailing address:
  • Phone: 610-568-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. WIDA AHMADI
Title or Position: DIRECTOR OF NURSING
Credential: RN
Phone: 610-568-5583