MEDICARE: GUARDIAN ANGEL HEALTH CARE SERVICES, INC.

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1760917736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN ANGEL HEALTH CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1537 N ZARAGOZA RD STE 1A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8095
Country	:	US
Telephone Number	:	915-373-5806
Fax Number	:

Provider Business Practice Location Address
First Line	:	1537 N ZARAGOZA RD STE 1A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8095
Country	:	US
Telephone Number	:	915-373-5806
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARGARET IKE
Credential	:
Telephone Number	:	9159153735806

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	05/02/2017

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