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General NPI Number Information
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NPI Number | 1871087080
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Entity Type | Organization
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Legal Business Name | GUARDIAN HAVEN ACADEMY
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 5806 BRECKENRIDGE PKWY STE B
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City | TAMPA
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State | FL
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Zip | 33610-4211
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Country | US
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Telephone | 813-400-2117
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Fax |
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Provider Business Mailing Address
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Address Line | 7853 GUNN HWY # 109
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City | TAMPA
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State | FL
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Zip | 33626-1611
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Country | US
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Telephone | 813-400-2117
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NAKISHA LAVELL VARLACK
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Credential |
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Telephone | 813-400-2117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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