Healthcare Provider Details

I. General information

NPI: 1891358974
Provider Name (Legal Business Name): GUARDIAN HOME HEALTH AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 LANKERSHIM BLVD STE 716
TOLUCA LAKE CA
91602-1887
US

IV. Provider business mailing address

4605 LANKERSHIM BLVD STE 716
TOLUCA LAKE CA
91602-1887
US

V. Phone/Fax

Practice location:
  • Phone: 747-202-1502
  • Fax: 800-862-8192
Mailing address:
  • Phone: 747-202-1502
  • Fax: 800-862-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: OLEH VAKRUSHEV
Title or Position: EMPLOYEE
Credential:
Phone: 747-202-1502