Provider Demographics
NPI:1508105370
Name:GUARDIAN HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:GUARDIAN HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEQUILLA
Authorized Official - Middle Name:LASHOWN
Authorized Official - Last Name:CARR-MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-238-7796
Mailing Address - Street 1:6708 DUTTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-2415
Mailing Address - Country:US
Mailing Address - Phone:763-238-7796
Mailing Address - Fax:
Practice Address - Street 1:6708 DUTTON AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428
Practice Address - Country:US
Practice Address - Phone:763-238-7796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN359811251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health