Provider Demographics
NPI:1114355476
Name:INDEPENDENT GUARDIAN LLC
Entity Type:Organization
Organization Name:INDEPENDENT GUARDIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-880-1742
Mailing Address - Street 1:550 S ESTELLE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2909
Mailing Address - Country:US
Mailing Address - Phone:316-880-1742
Mailing Address - Fax:
Practice Address - Street 1:550 S ESTELLE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2909
Practice Address - Country:US
Practice Address - Phone:316-880-1742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS200566240A385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child