Provider Demographics
NPI:1538569942
Name:GUARDIAN ANGEL HOME HEALTH INC
Entity type:Organization
Organization Name:GUARDIAN ANGEL HOME HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:OTUYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-504-8322
Mailing Address - Street 1:5680 KING CENTRE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5755
Mailing Address - Country:US
Mailing Address - Phone:703-519-1255
Mailing Address - Fax:703-454-0722
Practice Address - Street 1:5680 KING CENTRE DR STE 600
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5755
Practice Address - Country:US
Practice Address - Phone:703-519-1255
Practice Address - Fax:703-454-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 253Z00000X, 385H00000X
VAHCO151190251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-211168OtherVIRGINIA DEPARTMENT OF HEALTH
VA2016315562Medicaid