Healthcare Provider Details

I. General information

NPI: 1710176151
Provider Name (Legal Business Name): GUARDIANTRAC. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 BROADUS ST
STURGIS MI
49091
US

IV. Provider business mailing address

215 BROADUS ST
STURGIS MI
49091-1384
US

V. Phone/Fax

Practice location:
  • Phone: 269-651-4500
  • Fax:
Mailing address:
  • Phone: 877-659-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN CARMICHAEL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 877-659-4500