Provider Demographics
NPI:1053865659
Name:GUARDIAN HOSPICE MN LLC
Entity Type:Organization
Organization Name:GUARDIAN HOSPICE MN LLC
Other - Org Name:MOMENTS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIYAHU
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-800-0908
Mailing Address - Street 1:820 LILAC DR N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4700
Mailing Address - Country:US
Mailing Address - Phone:763-205-3600
Mailing Address - Fax:
Practice Address - Street 1:820 LILAC DR N
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4700
Practice Address - Country:US
Practice Address - Phone:763-205-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
MN32588251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN32588OtherSTATE LICENSE