Provider Demographics
NPI:1174610448
Name:GUARDIAN ANGELS ELIM HOME CARE, INC
Entity type:Organization
Organization Name:GUARDIAN ANGELS ELIM HOME CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-241-0654
Mailing Address - Street 1:403 MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1533
Mailing Address - Country:US
Mailing Address - Phone:763-241-0654
Mailing Address - Fax:763-241-0274
Practice Address - Street 1:403 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1533
Practice Address - Country:US
Practice Address - Phone:763-241-0654
Practice Address - Fax:763-241-0274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332158251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3153GUOtherBCBS/BLUE PLUS
MN126627600Medicaid