=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376452136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUARDIAN ANGEL HOMES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2026
-----------------------------------------------------
Last Update Date | 09/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1815 LASALLE ST LOWR
-----------------------------------------------------
City | RACINE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53402-4629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-260-8565
-----------------------------------------------------
Fax | 262-290-4882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2312 16TH PL
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53140-1812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-883-7817
-----------------------------------------------------
Fax | 262-290-4882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NATASHA L EVANS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 262-883-7817
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------