MEDICARE: GUARDIAN HOME HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	FCL-032-151	NC

General Provider Information

NPI Number	:	1275081580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN HOME HEALTHCARE

Provider Business Mailing Address
First Line	:	130 SELSEY DR
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4908
Country	:	US
Telephone Number	:	919-426-1653
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 SELSEY DR
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4908
Country	:	US
Telephone Number	:	919-426-1653
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ONYE PAUL ONUOHA
Credential	:
Telephone Number	:	919-426-1653

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	12/22/2016

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