Provider Demographics
NPI:1467998021
Name:GUARDIAN HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:GUARDIAN HEALTH CARE SERVICES
Other - Org Name:D'AMORE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:WOODFORD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-892-3020
Mailing Address - Street 1:3044 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2855
Mailing Address - Country:US
Mailing Address - Phone:949-402-9520
Mailing Address - Fax:714-242-9700
Practice Address - Street 1:3044 GRANT AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2855
Practice Address - Country:US
Practice Address - Phone:949-402-9520
Practice Address - Fax:714-242-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMHBS160214323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306005248OtherCALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CAMHBS160214OtherCALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES