MEDICARE: GUARDIAN HEALTH CARE INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	251J00000X	Nursing Care Agency	MO
2	163WH0200X	Home Health Registered Nurse	MO
3	302R00000X	Health Maintenance Organization	MO
4	372500000X	Chore Provider	MO
5	372600000X	Adult Companion	MO
6	3747P1801X	Personal Care Attendant	MO
7	163W00000X	Registered Nurse	MO
8	376J00000X	Homemaker	MO
9	376K00000X	Nurse's Aide	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00001152	OTHER	MO	SSBG

General Provider Information

NPI Number	:	1649318072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN HEALTH CARE INC

Provider Business Mailing Address
First Line	:	5405 OLD STATE ROUTE 21
Second Line	:
City	:	HOUSE SPRINGS
State	:	MO
Zip	:	63051-2439
Country	:	US
Telephone Number	:	636-942-4417
Fax Number	:	636-942-5997

Provider Business Practice Location Address
First Line	:	5405 OLD STATE ROUTE 21
Second Line	:
City	:	HOUSE SPRINGS
State	:	MO
Zip	:	63051-2439
Country	:	US
Telephone Number	:	636-942-4417
Fax Number	:	636-942-5997

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. MARJORY MAE LARONGE
Credential	:
Telephone Number	:	636-942-4417

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	10/21/2008

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