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General NPI Number Information
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NPI Number | 1265095590
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Entity Type | Organization
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Legal Business Name | A GUARDIAN ANGEL HOME HEALTH CARE
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 04/22/2019
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Provider Practice Location Address
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Address Line | 140 W WASHINGTON ST SUITE 109
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City | SUFFOLK
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State | VA
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Zip | 23434-5254
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Country | US
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Telephone | 757-610-7430
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Fax | 757-922-7019
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Provider Business Mailing Address
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Address Line | 140 W WASHINGTON ST SUITE 109
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City | SUFFOLK
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State | VA
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Zip | 23434-5254
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Country | US
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Telephone | 757-610-7430
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Fax | 757-922-7019
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NICHELL YVETTE LEWIS
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Credential |
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Telephone | 757-610-7430
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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 |
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License Number State |
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