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General NPI Number Information
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NPI Number | 1811291024
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Entity Type | Organization
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Legal Business Name | ANGELS ON GUARD
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 9552 ROUTE 408 SOUTH RD
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City | NUNDA
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State | NY
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Zip | 14517
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Country | US
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Telephone | 585-468-5570
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 576
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City | NUNDA
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State | NY
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Zip | 14517-0576
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KATHLEENANNE EVANS
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Credential | RN, BS EDU, LMT
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Telephone | 585-468-5570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 271796
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License Number State | NY
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