Provider Demographics
NPI:1215494117
Name:GUARDIAN ANGELS HOMEMAKER SERVICES
Entity type:Organization
Organization Name:GUARDIAN ANGELS HOMEMAKER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-392-3965
Mailing Address - Street 1:207 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2703
Mailing Address - Country:US
Mailing Address - Phone:662-392-3965
Mailing Address - Fax:
Practice Address - Street 1:612 SUNFLOWER AVENUE EXT STE 19B
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2333
Practice Address - Country:US
Practice Address - Phone:662-392-3965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLNESS PERSONAL CARE SERVICE LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care