MEDICARE: GUARDIAN ANGEL CAREGIVER

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	199145	FL

General Provider Information

NPI Number	:	1699089334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN ANGEL CAREGIVER

Provider Business Mailing Address
First Line	:	4036 DIAMOND LEAF CT
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3610
Country	:	US
Telephone Number	:	727-787-6002
Fax Number	:	727-787-6002

Provider Business Practice Location Address
First Line	:	4036 DIAMOND LEAF CT
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3610
Country	:	US
Telephone Number	:	727-787-6002
Fax Number	:	727-787-6002

Authorized Official
Title or Position	:	HOME HEATH AID CNA
Name	:	MRS. SUSAN E HOCH
Credential	:	H.H.A-C.NA
Telephone Number	:	727-787-6002

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	08/05/2010

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