Provider Demographics
NPI:1164882254
Name:GUARDIAN HOME CARE
Entity Type:Organization
Organization Name:GUARDIAN HOME CARE
Other - Org Name:AMADA SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERSHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-881-0014
Mailing Address - Street 1:3560 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 3-A
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4446
Mailing Address - Country:US
Mailing Address - Phone:253-881-0014
Mailing Address - Fax:253-320-7440
Practice Address - Street 1:3560 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 3-A
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4446
Practice Address - Country:US
Practice Address - Phone:253-881-0014
Practice Address - Fax:253-320-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603163787251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health