Provider Demographics
NPI:1447515812
Name:GUARDIAN ANGEL HOME CARE AGENCY, LLC
Entity type:Organization
Organization Name:GUARDIAN ANGEL HOME CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-633-9730
Mailing Address - Street 1:1532 N HARBOR CITY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6533
Mailing Address - Country:US
Mailing Address - Phone:321-633-9730
Mailing Address - Fax:321-633-5061
Practice Address - Street 1:1532 N HARBOR CITY BLVD STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6533
Practice Address - Country:US
Practice Address - Phone:321-633-9730
Practice Address - Fax:321-633-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211549251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care