Provider Demographics
NPI:1093165375
Name:GUARDIAN HALO HEALTH CARE LLC
Entity Type:Organization
Organization Name:GUARDIAN HALO HEALTH CARE LLC
Other - Org Name:GUARDIAN HALO HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:OMONKHUALE
Authorized Official - Last Name:MADOJEMIU
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MSC, MSM, CTM
Authorized Official - Phone:228-471-5249
Mailing Address - Street 1:4341 GAUTIER VANCLEAVE ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5824
Mailing Address - Country:US
Mailing Address - Phone:228-471-5249
Mailing Address - Fax:228-471-5249
Practice Address - Street 1:4341 GAUTIER VANCLEAVE ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5824
Practice Address - Country:US
Practice Address - Phone:228-471-5249
Practice Address - Fax:228-471-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No332900000XSuppliersNon-Pharmacy Dispensing Site
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335G00000XSuppliersMedical Foods Supplier
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child