Healthcare Provider Details

I. General information

NPI: 1578823928
Provider Name (Legal Business Name): GUARDIAN CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2012
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W RAILROAD AVE N
CRYSTAL SPRINGS MS
39059-2154
US

IV. Provider business mailing address

408 STONEWATER CV
MADISON MS
39110-4405
US

V. Phone/Fax

Practice location:
  • Phone: 601-415-9533
  • Fax:
Mailing address:
  • Phone: 601-415-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNA W OBERHOUSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-415-9533