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Organization Active NPI

Guardian Angel Home Health Care, Inc

  • Home Health Agency
  • Bicknell, IN
National Provider Identifier
1295789022
Registry record updated Dec 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
06009556 Issued in IN
Legal business name
GUARDIAN ANGEL HOME HEALTH CARE, INC
Practice address
11617 E Sr 67
Bicknell, IN 47512-0095
Phone
(812) 735-2811
Fax
(812) 735-2332
NPI assigned
May 19, 2006
Last updated
Dec 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Shelby Lynn Marchino
Title
Chief Financial Officer
Phone
(812) 735-2811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 06009556 IN Primary

Addresses

Primary practice location

11617 E Sr 67
Bicknell, IN 47512-0095

Mailing address

11617 E Sr 67
PO Box 95
Bicknell, IN 47512-0095
Phone (812) 735-2811

Other identifiers 2

IdentifierTypeStateIssuer
200130650MedicaidIN
200141920OtherINMEDWAIVER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100806000243 IN Part A Provider - Home Health Agency 6507999844 Practice locations: Bicknell, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295789022. Details of each certification follow.

Home health agency certification: CCN 157503

Legal name
GUARDIAN ANGEL HOME HEALTH CARE, INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 10, 1997
Last certification
Sep 16, 2021
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Nov 22, 1996 in IN
Enrollment address
11617 East State Road 67
Bicknell, IN 47512-0095

Care Compare: Home health agency

Medicare Care Compare
Listed as
Guardian Angels Home Health Care, IncCCN 157503 · All quality measures
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Mar 10, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Occupational therapy

National Provider Directory

National Provider Directory

Locations

11617 E State Road 67
Bicknell, IN 47512
Phone (812) 735-2811

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lori Marchino Individual 5% Or Greater Direct Ownership InterestAdministrator May 15, 2014 50%
Corporate Director Jan 7, 1997
W-2 Managing Employee Jan 7, 1997
Selby Marchino Individual 5% Or Greater Direct Ownership InterestVice President Nov 1, 2016 50%
Corporate Officer Nov 1, 2016
Corporate Director Nov 1, 2016
W-2 Managing Employee Nov 1, 2016

Practitioners & affiliated clinicians

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1295789022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11617 E SR 67",
            "address_2": "PO BOX 95",
            "city": "BICKNELL",
            "state": "IN",
            "postal_code": "475120095",
            "telephone_number": "812-735-2811",
            "fax_number": "812-735-2332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11617 E SR 67",
            "city": "BICKNELL",
            "state": "IN",
            "postal_code": "475120095",
            "telephone_number": "812-735-2811",
            "fax_number": "812-735-2332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGEL HOME HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "MARCHINO",
        "authorized_official_first_name": "SHELBY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "812-735-2811",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IN",
            "license": "06009556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200130650",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDWAIVER",
            "identifier": "200141920",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bicknell, IN

Sources for this page

Verify at the official NPI Registry.