Provider Demographics
NPI:1639127863
Name:GUARDIAN HEALTH SERVICES
Entity Type:Organization
Organization Name:GUARDIAN HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MAED
Authorized Official - Phone:828-324-3025
Mailing Address - Street 1:343 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-4904
Mailing Address - Country:US
Mailing Address - Phone:828-324-3025
Mailing Address - Fax:
Practice Address - Street 1:328 MULBERRY ST SW
Practice Address - Street 2:SUITE 4
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5717
Practice Address - Country:US
Practice Address - Phone:828-757-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0057251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600845Medicaid
NC7100451OtherPRIVATE DUTY
NC3409446Medicaid