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General NPI Number Information
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NPI Number | 1871043752
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGEL HOME HEALTH, INC.
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 2800 HUTTON AVE
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City | FARMINGTON
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State | NM
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Zip | 87402-4560
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Country | US
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Telephone | 505-564-9002
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Fax | 505-564-9022
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Provider Business Mailing Address
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Address Line | PO BOX 3590
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City | FARMINGTON
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State | NM
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Zip | 87499-3590
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Country | US
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Telephone | 505-564-9002
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Fax | 505-564-9022
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. DIXIE LEIGH THOMPSON
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Credential | RN
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Telephone | 505-564-9002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3132
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License Number State | NM
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