Provider Demographics
NPI:1407110950
Name:GUARDIAN HEALTHCARE NEWCO, LLC
Entity Type:Organization
Organization Name:GUARDIAN HEALTHCARE NEWCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-491-4711
Mailing Address - Street 1:1575 HERITAGE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069
Mailing Address - Country:US
Mailing Address - Phone:214-491-4711
Mailing Address - Fax:214-491-4047
Practice Address - Street 1:7265 KENWOOD RD
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4400
Practice Address - Country:US
Practice Address - Phone:513-842-1101
Practice Address - Fax:513-842-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health