Provider Demographics
NPI:1235631094
Name:GUARDIAN HOSPICE, LLC
Entity Type:Organization
Organization Name:GUARDIAN HOSPICE, LLC
Other - Org Name:ARIZONA LIFE HOSPICE - MOHAVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-278-7691
Mailing Address - Street 1:4824 E BASELINE RD STE 133
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4680
Mailing Address - Country:US
Mailing Address - Phone:480-604-4110
Mailing Address - Fax:
Practice Address - Street 1:5225 S HIGHWAY 95 STE 7
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9111
Practice Address - Country:US
Practice Address - Phone:928-278-7691
Practice Address - Fax:928-577-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ083853Medicaid