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General NPI Number Information
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NPI Number | 1124279815
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Entity Type | Organization
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Legal Business Name | GUARDIAN HEALTHCARE AND HOSPICE,LLC
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 181 WAUKEGAN RD SUITE 301
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City | NORTHFIELD
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State | IL
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Zip | 60093-2755
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Country | US
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Telephone | 847-446-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 181 WAUKEGAN RD SUITE 301
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City | NORTHFIELD
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State | IL
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Zip | 60093-2755
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Country | US
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Telephone | 847-446-0000
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PETER MANDELLOS
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Credential |
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Telephone | 846-446-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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