Provider Demographics
NPI:1003995507
Name:GUARDIAN HOSPICE CARE, LLC
Entity Type:Organization
Organization Name:GUARDIAN HOSPICE CARE, LLC
Other - Org Name:GUARDIAN HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-709-1408
Mailing Address - Street 1:5503 JOHN ESKEW BLVD
Mailing Address - Street 2:SUITE B & C
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3725
Mailing Address - Country:US
Mailing Address - Phone:318-484-4418
Mailing Address - Fax:318-484-2732
Practice Address - Street 1:5503 JOHN ESKEW BLVD
Practice Address - Street 2:SUITE B & C
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3725
Practice Address - Country:US
Practice Address - Phone:318-484-4418
Practice Address - Fax:318-484-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1001511Medicaid
LA191637Medicare Oscar/Certification