=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487799458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUARDIAN CARE HOME HEALTH AGENCY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 06/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9950 WESTPARK DR STE 103D
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-434-6289
-----------------------------------------------------
Fax | 832-991-8869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9950 WESTPARK DR STE 103D
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77063-5379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-434-6289
-----------------------------------------------------
Fax | 832-991-8869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | SHAHRAM BAVAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-679-1010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 678238
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------