Healthcare Provider Details

I. General information

NPI: 1801838511
Provider Name (Legal Business Name): GUARDIAN HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WILLOW LAWN DR SUITE #210
RICHMOND VA
23230-3003
US

IV. Provider business mailing address

1700 WILLOW LAWN DR. SUITE #210
RICHMOND VA
23230-3409
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-9999
  • Fax: 804-282-5555
Mailing address:
  • Phone: 804-282-9999
  • Fax: 804-282-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-07344
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateVA

VIII. Authorized Official

Name: MRS. JONI MARIE HEMMIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 804-282-9999