Healthcare Provider Details

I. General information

NPI: 1093654899
Provider Name (Legal Business Name): GUARDIAN KARE RESIDENTIAL SUITES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NW 25TH ST
OKLAHOMA CITY OK
73106-5619
US

IV. Provider business mailing address

3704 OAK GROVE DR
MIDWEST CITY OK
73110-3730
US

V. Phone/Fax

Practice location:
  • Phone: 405-768-8311
  • Fax:
Mailing address:
  • Phone: 405-408-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMALA HUBBARD
Title or Position: OWNER
Credential:
Phone: 405-408-7029