MEDICARE: DV GUARDIAN SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	344600000X	Taxi

General Provider Information

NPI Number	:	1184586067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DV GUARDIAN SERVICES LLC

Provider Business Mailing Address
First Line	:	1307 W LINCOLN HWY APT 3102
Second Line	:
City	:	DEKALB
State	:	IL
Zip	:	60115-2931
Country	:	US
Telephone Number	:	815-556-9712
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 W LINCOLN HWY APT 3102
Second Line	:
City	:	DEKALB
State	:	IL
Zip	:	60115-2931
Country	:	US
Telephone Number	:	815-556-9712
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DAMESIHA S VANCE
Credential	:
Telephone Number	:	708-781-8789

Provider Enumeration Date	:	11/28/2025
Last Update Date	:	11/28/2025

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