MEDICARE: GUARD AN ANGEL HOMECARE SERVICES

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1841764594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARD AN ANGEL HOMECARE SERVICES

Provider Business Mailing Address
First Line	:	4435 ALGERNON DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-6803
Country	:	US
Telephone Number	:	281-845-1141
Fax Number	:

Provider Business Practice Location Address
First Line	:	4435 ALGERNON DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-6803
Country	:	US
Telephone Number	:	281-845-1141
Fax Number	:

Authorized Official
Title or Position	:	LVN
Name	:	WENDY R BRACKENS
Credential	:	NURSE/LVN
Telephone Number	:	281-845-1144

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	01/16/2019

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