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General NPI Number Information
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NPI Number | 1578823928
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Entity Type | Organization
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Legal Business Name | GUARDIAN CARE LLC.
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Dates
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Enumeration Date | 05/19/2012
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 104 W RAILROAD AVE N
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City | CRYSTAL SPRINGS
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State | MS
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Zip | 39059-2154
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Country | US
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Telephone | 601-415-9533
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Fax |
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Provider Business Mailing Address
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Address Line | 408 STONEWATER CV
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City | MADISON
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State | MS
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Zip | 39110-4405
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Country | US
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Telephone | 601-415-9533
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ANNA W OBERHOUSEN
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Credential |
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Telephone | 601-415-9533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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