Provider Demographics
NPI:1730730508
Name:GUARDIAN ANGELS HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:GUARDIAN ANGELS HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:763-241-4428
Mailing Address - Street 1:508 FREEPORT AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1874
Mailing Address - Country:US
Mailing Address - Phone:763-635-4483
Mailing Address - Fax:763-241-4443
Practice Address - Street 1:9200 QUANTRELLE AVE NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-1048
Practice Address - Country:US
Practice Address - Phone:763-746-3400
Practice Address - Fax:763-635-5480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUARDIAN ANGELS HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNM112023900OtherMN DEPARTMENT OF HUMAN SERVICES