Provider Demographics
NPI:1992516546
Name:GUARDIAN ANGELS HOMECARE LLC
Entity type:Organization
Organization Name:GUARDIAN ANGELS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-632-7799
Mailing Address - Street 1:15165 STATE ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:IL
Mailing Address - Zip Code:61078-9212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15165 STATE ROUTE 73
Practice Address - Street 2:
Practice Address - City:SHANNON
Practice Address - State:IL
Practice Address - Zip Code:61078-9212
Practice Address - Country:US
Practice Address - Phone:815-662-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care