MEDICARE: GUARDIAN ANGELS HEALTH 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	314000000X	Skilled Nursing Facility	00611	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861499204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN ANGELS HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	400 EVANS AVENUE
Second Line	:
City	:	ELK RIVER
State	:	MN
Zip	:	55330-2604
Country	:	US
Telephone Number	:	763-241-4400
Fax Number	:	763-241-4444

Provider Business Practice Location Address
First Line	:	400 EVANS AVENUE
Second Line	:
City	:	ELK RIVER
State	:	MN
Zip	:	55330-2604
Country	:	US
Telephone Number	:	763-241-4400
Fax Number	:	763-241-4444

Authorized Official
Title or Position	:	CEO
Name	:	MR. DANIEL CHARLES DIXON
Credential	:
Telephone Number	:	763-241-4439

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/14/2012

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