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General NPI Number Information
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NPI Number | 1659793412
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGELS CDS, LLC
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 105 W 12TH ST STE C
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-1817
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Country | US
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Telephone | 573-333-0777
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Fax | 573-333-1002
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Provider Business Mailing Address
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Address Line | 105 W 12TH ST STE C PO BOX 4
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-1817
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Country | US
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Telephone | 573-333-0777
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Fax | 573-333-1002
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Authorized Official
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Title or Position | CEO
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Name | MS. CARRIE HARRIS
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Credential |
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Telephone | 573-333-0777
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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 | MO
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