Provider Demographics
NPI:1538596481
Name:MY GUARDIAN ANGELS SENIOR CARE INC
Entity type:Organization
Organization Name:MY GUARDIAN ANGELS SENIOR CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-874-4170
Mailing Address - Street 1:9951 ATLANTIC BLVD
Mailing Address - Street 2:STE 423
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6584
Mailing Address - Country:US
Mailing Address - Phone:904-874-4170
Mailing Address - Fax:904-721-4123
Practice Address - Street 1:9951 ATLANTIC BLVD
Practice Address - Street 2:STE 423
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6584
Practice Address - Country:US
Practice Address - Phone:904-874-4170
Practice Address - Fax:904-721-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9243305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service