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General NPI Number Information
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NPI Number | 1417386541
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGEL HOME CARE AGENCY
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 1801 NORTH TRYON ST SUITE 305B
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City | HUNTERSVILLE
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State | NC
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Zip | 28070-2098
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Country | US
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Telephone | 704-948-5654
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 N TRYON ST SUITE 305B
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City | CHARLOTTE
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State | NC
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Zip | 28206-2704
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Country | US
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Telephone | 704-948-5658
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIAN F FUNDERBURK
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Credential | BS
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Telephone | 704-948-5654
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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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