Healthcare Provider Details

I. General information

NPI: 1619256740
Provider Name (Legal Business Name): MY GUARDIAN FOR LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2011
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 JUSTIN RD STE G
ROCKWALL TX
75087-4876
US

IV. Provider business mailing address

761 JUSTIN RD STE G
ROCKWALL TX
75087-4876
US

V. Phone/Fax

Practice location:
  • Phone: 972-722-7490
  • Fax: 972-722-7403
Mailing address:
  • Phone: 972-722-7490
  • Fax: 972-722-7403

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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BRENDA KEILERS
Title or Position: CEO
Credential:
Phone: 214-500-6332