Healthcare Provider Details

I. General information

NPI: 1467998021
Provider Name (Legal Business Name): GUARDIAN HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3044 GRANT AVE
COSTA MESA CA
92626-2855
US

IV. Provider business mailing address

3044 GRANT AVE
COSTA MESA CA
92626-2855
US

V. Phone/Fax

Practice location:
  • Phone: 949-402-9520
  • Fax: 714-242-9700
Mailing address:
  • Phone: 949-402-9520
  • Fax: 714-242-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberMHBS160214
License Number StateCA

VIII. Authorized Official

Name: BENJAMIN WOODFORD SMITH
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 949-892-3020