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General NPI Number Information
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NPI Number | 1073974929
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGELS OF PINELLAS
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 4374 RIDGEMOOR DR
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City | PALM HARBOR
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State | FL
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Zip | 34685-1165
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Country | US
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Telephone | 727-307-0345
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Fax | 727-674-2932
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Provider Business Mailing Address
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Address Line | PO BOX 16011
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City | CLEARWATER
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State | FL
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Zip | 33766-6011
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Country | US
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Telephone | 727-307-0345
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Fax | 727-674-2932
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Authorized Official
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Title or Position | CNA
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Name | MS. MARISA ANN HAMPSHIRE
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Credential | CNA
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Telephone | 727-307-0345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 266958
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License Number State | FL
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