Healthcare Provider Details

I. General information

NPI: 1609798453
Provider Name (Legal Business Name): THE GUARDIAN GROUNDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 TRONERO WAY
RANCHO CORDOVA CA
95670-3610
US

IV. Provider business mailing address

1187 RESTON DR
FOLSOM CA
95630-3608
US

V. Phone/Fax

Practice location:
  • Phone: 916-460-8579
  • Fax:
Mailing address:
  • Phone: 916-460-8579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: GARY TRAVIS
Title or Position: FOUNDER / CEO
Credential:
Phone: 916-460-8579