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General NPI Number Information
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NPI Number | 1962927418
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGELS PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 08/06/2017
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Last Update Date | 08/06/2017
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Provider Practice Location Address
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Address Line | 2614 E HIGHWAY 76 STE E
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City | MARION
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State | SC
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Zip | 29571-6336
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Country | US
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Telephone | 843-446-8811
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Fax | 843-446-8811
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Provider Business Mailing Address
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Address Line | PO BOX 1471
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City | MARION
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State | SC
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Zip | 29571-1471
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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 | OWNER
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Name | MS. PATRICIA MONTGOMERY
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Credential | RN, MSN, CRRN
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Telephone | 843-503-1209
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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 | 2017-160736
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License Number State | SC
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