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General NPI Number Information
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NPI Number | 1871765487
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGELS PRIMARY HOME CARE, INC.
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 2808 MEMORIAL JR HIGH DR
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City | EAGLE PASS
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State | TX
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Zip | 78852-3894
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Country | US
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Telephone | 830-421-8653
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Fax | 830-773-0008
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Provider Business Mailing Address
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Address Line | 2808 MEMORIAL JR HIGH DR PO BOX 702
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City | EAGLE PASS
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State | TX
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Zip | 78852-3894
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Country | US
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Telephone | 830-421-8653
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Fax | 830-773-0008
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Authorized Official
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Title or Position | OWNER
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Name | BLANCA E PERALES
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Credential |
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Telephone | 830-421-8653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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