Organization
GUARDIAN ANGELS HEALTH SERVICES, INC.
Active
Parent organization
GUARDIAN ANGELS HEALTH SERVICES, INC.
Other names
Angels On Main
Organization subpart
Yes
Provider details
NPI number
Legal business name
GUARDIAN ANGELS HEALTH SERVICES, INC.
Authorized official
DANIEL JAMES FAIR DO (ADMINISTRATOR)
(763) 241-4428
Entity
Organization
Contact information
Practice address
9200 QUANTRELLE AVE NE, OTSEGO, MN 55330-1048
(763) 746-3400
(763) 635-5480
Mailing address
508 FREEPORT AVE NW STE A, ELK RIVER, MN 55330-1874
(763) 635-4483
(763) 241-4443
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M112023900
MN DEPARTMENT OF HUMAN SERVICES
MN
Enumeration date
09/24/2019
Last updated
09/24/2019
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