MEDICARE: GUARDIAN HOME SUPPORT LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1578378428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUARDIAN HOME SUPPORT LLC

Provider Business Mailing Address
First Line	:	145 25TH AVE S STE 215
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-3900
Country	:	US
Telephone Number	:	651-418-9040
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 25TH AVE S STE 215
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-3900
Country	:	US
Telephone Number	:	651-418-9040
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MAKHTAL D WARSAME
Credential	:
Telephone Number	:	952-228-1419

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	01/23/2026

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Directions to “GUARDIAN HOME SUPPORT LLC ” Practice Location

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