Provider Demographics
NPI:1841736097
Name:A GUARDIAN CARE GROUP
Entity Type:Organization
Organization Name:A GUARDIAN CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,RN
Authorized Official - Phone:901-352-5280
Mailing Address - Street 1:2502 MT. MORIAH SUITE A101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38018
Mailing Address - Country:US
Mailing Address - Phone:901-352-5280
Mailing Address - Fax:
Practice Address - Street 1:10164 GREEN MOSS
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018
Practice Address - Country:US
Practice Address - Phone:901-352-5280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health