Healthcare Provider Details

I. General information

NPI: 1336074657
Provider Name (Legal Business Name): GUARDIAN MOBILITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CHELSEA DR APT 223
EDMOND OK
73013-4311
US

IV. Provider business mailing address

1600 CHELSEA DR APT 223
EDMOND OK
73013-4311
US

V. Phone/Fax

Practice location:
  • Phone: 405-938-9050
  • Fax:
Mailing address:
  • Phone: 405-938-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SHADRACH FOFANAH SR.
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 405-938-9050