Healthcare Provider Details

I. General information

NPI: 1538072996
Provider Name (Legal Business Name): GUARDIAN ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19186 COCHISE PL
APPLE VALLEY CA
92308-6015
US

IV. Provider business mailing address

6110 BIG HORN DR
RIVERSIDE CA
92506-4634
US

V. Phone/Fax

Practice location:
  • Phone: 909-434-4955
  • Fax:
Mailing address:
  • Phone: 909-434-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ALEJANDRO GARCIA
Title or Position: LICENSEE
Credential:
Phone: 909-434-4955