Provider Demographics
NPI:1154963502
Name:GUARDIAN ANGEL HOME CARE SERVICES, INC.
Entity type:Organization
Organization Name:GUARDIAN ANGEL HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-392-4243
Mailing Address - Street 1:6572 SEMINOLE BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-6347
Mailing Address - Country:US
Mailing Address - Phone:727-392-4243
Mailing Address - Fax:727-392-4232
Practice Address - Street 1:6572 SEMINOLE BLVD STE 8
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-6347
Practice Address - Country:US
Practice Address - Phone:727-392-4243
Practice Address - Fax:727-392-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health