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General NPI Number Information
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NPI Number | 1538596481
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Entity Type | Organization
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Legal Business Name | MY GUARDIAN ANGELS SENIOR CARE INC
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Dates
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Enumeration Date | 10/07/2013
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Last Update Date | 10/07/2013
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Provider Practice Location Address
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Address Line | 9951 ATLANTIC BLVD STE 423
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City | JACKSONVILLE
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State | FL
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Zip | 32225-6584
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Country | US
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Telephone | 904-874-4170
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Fax | 904-721-4123
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Provider Business Mailing Address
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Address Line | 9951 ATLANTIC BLVD STE 423
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City | JACKSONVILLE
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State | FL
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Zip | 32225-6584
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Country | US
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Telephone | 904-874-4170
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Fax | 904-721-4123
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Authorized Official
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Title or Position | OWNER
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Name | LEOLA NELSON
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Credential |
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Telephone | 904-874-4170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 9243
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License Number State | FL
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