Provider Demographics
NPI:1003848573
Name:GUARDIAN HOME CARE MID-CUMBERLAND, LLC
Entity Type:Organization
Organization Name:GUARDIAN HOME CARE MID-CUMBERLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-385-5228
Mailing Address - Street 1:1220 HWY 327 EAST
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656
Mailing Address - Country:US
Mailing Address - Phone:409-385-5228
Mailing Address - Fax:409-385-4322
Practice Address - Street 1:8 MATHIS DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-7038
Practice Address - Country:US
Practice Address - Phone:615-441-1747
Practice Address - Fax:615-441-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000074251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003848573Medicare Oscar/Certification