Provider Demographics
NPI:1730894791
Name:LIFE GUARDIAN ANGELS HOMECARE LLC
Entity type:Organization
Organization Name:LIFE GUARDIAN ANGELS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TESHON
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-885-9152
Mailing Address - Street 1:6842 S CLYDE AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-1609
Mailing Address - Country:US
Mailing Address - Phone:773-954-4385
Mailing Address - Fax:
Practice Address - Street 1:600 HOLIDAY PLAZA DR STE 184
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2236
Practice Address - Country:US
Practice Address - Phone:773-954-4385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care