Provider Demographics
NPI:1144326711
Name:GUARDIAN ANGEL HOSPICE CARE FOR CHILDREN
Entity type:Organization
Organization Name:GUARDIAN ANGEL HOSPICE CARE FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:DUNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN/MHA
Authorized Official - Phone:601-720-1187
Mailing Address - Street 1:514 W FULTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4254
Mailing Address - Country:US
Mailing Address - Phone:601-720-1187
Mailing Address - Fax:601-859-1881
Practice Address - Street 1:514 W FULTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4254
Practice Address - Country:US
Practice Address - Phone:601-720-1187
Practice Address - Fax:601-859-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS117251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01785796Medicaid