Provider Demographics
NPI:1790923506
Name:GUARDIAN FAMILY CARE, INC.
Entity Type:Organization
Organization Name:GUARDIAN FAMILY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-289-5229
Mailing Address - Street 1:1698 IOWA DR
Mailing Address - Street 2:PO BOX 37
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-9231
Mailing Address - Country:US
Mailing Address - Phone:563-289-5229
Mailing Address - Fax:563-289-3444
Practice Address - Street 1:1698 IOWA DR
Practice Address - Street 2:
Practice Address - City:LE CLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-9231
Practice Address - Country:US
Practice Address - Phone:563-289-5229
Practice Address - Fax:563-289-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3000309253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000453274Medicaid