Healthcare Provider Details

I. General information

NPI: 1376452136
Provider Name (Legal Business Name): GUARDIAN ANGEL HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 LASALLE ST LOWR
RACINE WI
53402-4629
US

IV. Provider business mailing address

2312 16TH PL
KENOSHA WI
53140-1812
US

V. Phone/Fax

Practice location:
  • Phone: 262-260-8565
  • Fax: 262-290-4882
Mailing address:
  • Phone: 262-883-7817
  • Fax: 262-290-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: NATASHA L EVANS
Title or Position: OWNER
Credential:
Phone: 262-883-7817