Healthcare Provider Details

I. General information

NPI: 1275459059
Provider Name (Legal Business Name): GUARDIAN 4 HEROES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 US 71 N
SAUK CENTRE MN
56378-1144
US

IV. Provider business mailing address

24 FAIRY LAKE RD
SAUK CENTRE MN
56378-1901
US

V. Phone/Fax

Practice location:
  • Phone: 320-828-2477
  • Fax:
Mailing address:
  • Phone: 320-828-2477
  • Fax: 320-828-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARA AMANDA ELLENSON-RISDAL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 320-828-2477