Provider Demographics
NPI:1871899450
Name:GUARDIAN ANGEL HOME HEALTH CARE ,INC
Entity type:Organization
Organization Name:GUARDIAN ANGEL HOME HEALTH CARE ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHIKERE
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAGBARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-629-2750
Mailing Address - Street 1:6029 RAYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3909
Mailing Address - Country:US
Mailing Address - Phone:314-629-2750
Mailing Address - Fax:816-737-3090
Practice Address - Street 1:6029 RAYTOWN RD
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3909
Practice Address - Country:US
Practice Address - Phone:314-629-2750
Practice Address - Fax:816-737-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266342807Medicaid
MO286342803Medicaid