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General NPI Number Information
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NPI Number | 1104791920
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGEL PERSONAL CARE SERVICE LLC
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Dates
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Enumeration Date | 10/09/2025
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 22748 LINWOOD AVE
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City | LAWTEY
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State | FL
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Zip | 32058-4307
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Country | US
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Telephone | 904-782-7315
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Fax |
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Provider Business Mailing Address
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Address Line | 22748 LINWOOD AVE
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City | LAWTEY
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State | FL
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Zip | 32058-4307
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Country | US
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Telephone | 904-782-7315
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | NEQUILA L BERRY
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Credential | CEO
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Telephone | 904-782-7315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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