Provider Demographics
NPI:1932449980
Name:GUARDIAN ANGELS REFERRAL AGENCY
Entity type:Organization
Organization Name:GUARDIAN ANGELS REFERRAL AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAEKO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-588-0246
Mailing Address - Street 1:4074 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3767
Mailing Address - Country:US
Mailing Address - Phone:954-588-0246
Mailing Address - Fax:954-583-9973
Practice Address - Street 1:4074 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3767
Practice Address - Country:US
Practice Address - Phone:954-588-0246
Practice Address - Fax:954-583-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232693253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL232693OtherAHCA