Organization
GUARDIAN ANGELS CDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARRIE HARRIS (CEO)
(573) 333-0777
Entity
Organization
Contact information
Practice address
105 W 12TH ST STE C, CARUTHERSVILLE, MO 63830-1817
(573) 333-0777
(573) 333-1002
Mailing address
105 W 12TH ST STE C, PO BOX 4, CARUTHERSVILLE, MO 63830-1817
(573) 333-0777
(573) 333-1002
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MO
Enumeration date
01/14/2014
Last updated
01/14/2014
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