1215488192 NPI number — GUARDIAN ANGEL HOME HEALTH, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215488192 NPI number — GUARDIAN ANGEL HOME HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUARDIAN ANGEL HOME HEALTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215488192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3590
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87499-3590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-564-9002
Provider Business Mailing Address Fax Number:
505-564-9022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 HUTTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87402-4560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-564-9002
Provider Business Practice Location Address Fax Number:
505-564-9022
Provider Enumeration Date:
10/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
DIXIE
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
50055649002

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  3132 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51629861 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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