Healthcare Provider Details

I. General information

NPI: 1639707755
Provider Name (Legal Business Name): MY GUARDIAN LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 BROADWAY AVE
BEDFORD OH
44146-3642
US

IV. Provider business mailing address

708 BROADWAY AVE
BEDFORD OH
44146-3642
US

V. Phone/Fax

Practice location:
  • Phone: 216-630-3037
  • Fax: 440-757-5011
Mailing address:
  • Phone: 216-630-3037
  • Fax: 440-757-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY DIANE JOHNSON
Title or Position: OWNER
Credential: NURSE AIDE
Phone: 216-630-3037