Healthcare Provider Details

I. General information

NPI: 1871040931
Provider Name (Legal Business Name): GUARDIAN HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CHEYENNE STREET
COSTA MESA CA
92626-2860
US

IV. Provider business mailing address

16541 GOTHARD STREET SUITE 102
HUNTINGTON BEACH CA
92647-4471
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-1110
  • Fax:
Mailing address:
  • Phone: 714-375-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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