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General NPI Number Information
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NPI Number | 1275459059
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Entity Type | Organization
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Legal Business Name | GUARDIAN 4 HEROES
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Dates
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Enumeration Date | 06/26/2026
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Last Update Date | 06/26/2026
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Provider Practice Location Address
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Address Line | 310 US 71 N
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City | SAUK CENTRE
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State | MN
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Zip | 56378-1144
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Country | US
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Telephone | 320-828-2477
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Fax |
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Provider Business Mailing Address
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Address Line | 24 FAIRY LAKE RD
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City | SAUK CENTRE
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State | MN
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Zip | 56378-1901
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Country | US
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Telephone | 320-828-2477
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Fax | 320-828-2477
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SARA AMANDA ELLENSON-RISDAL
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Credential |
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Telephone | 320-828-2477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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