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General NPI Number Information
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NPI Number | 1578378428
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Entity Type | Organization
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Legal Business Name | GUARDIAN HOME SUPPORT LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 145 25TH AVE S STE 215
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City | SAINT CLOUD
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State | MN
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Zip | 56301-3900
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Country | US
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Telephone | 651-418-9040
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Fax |
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Provider Business Mailing Address
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Address Line | 145 25TH AVE S STE 215
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City | SAINT CLOUD
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State | MN
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Zip | 56301-3900
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Country | US
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Telephone | 651-418-9040
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MAKHTAL D WARSAME
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Credential |
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Telephone | 952-228-1419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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