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General NPI Number Information
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NPI Number | 1114560364
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGEL CARE MIHP
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Dates
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Enumeration Date | 10/21/2019
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 4609 S WAYNE RD STE 1
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City | WAYNE
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State | MI
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Zip | 48184-2310
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Country | US
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Telephone | 734-858-7709
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Fax | 734-858-7802
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Provider Business Mailing Address
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Address Line | 30169 JAMESTOWN ST
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City | ROMULUS
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State | MI
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Zip | 48174-3149
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Country | US
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Telephone | 734-858-7709
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Fax | 734-858-7802
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Authorized Official
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Title or Position | OWNER
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Name | TONJIA PETERSON
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Credential |
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Telephone | 734-858-7709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 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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