Healthcare Provider Details

I. General information

NPI: 1962295816
Provider Name (Legal Business Name): GUARDIAN HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10754 EL RUBI CIR
FOUNTAIN VALLEY CA
92708-3841
US

IV. Provider business mailing address

2900 BRISTOL ST STE H201
COSTA MESA CA
92626-7917
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: COMPLIANCE DIRECTOR
Credential:
Phone: 949-892-3020