MEDICARE: GUARDIAN ANGELS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1245686138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN ANGELS, LLC

Provider Business Mailing Address
First Line	:	106 W 11TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64105-1813
Country	:	US
Telephone Number	:	816-237-8063
Fax Number	:	816-421-1769

Provider Business Practice Location Address
First Line	:	106 W 11TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64105-1813
Country	:	US
Telephone Number	:	816-237-8063
Fax Number	:	816-421-1769

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CALVIN DON VICK
Credential	:
Telephone Number	:	913-481-9775

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	05/10/2016

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