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General NPI Number Information
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NPI Number | 1215494117
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGELS HOMEMAKER SERVICES
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 612 SUNFLOWER AVENUE EXT STE 19B
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City | INDIANOLA
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State | MS
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Zip | 38751-2333
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Country | US
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Telephone | 662-392-3965
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Fax |
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Provider Business Mailing Address
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Address Line | 207 ALEXANDER AVE
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City | INDIANOLA
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State | MS
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Zip | 38751-2703
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Country | US
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Telephone | 662-392-3965
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GWENDOLYN BLAKE
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Credential |
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Telephone | 662-392-3965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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