Provider Demographics
NPI:1881831931
Name:GUARDIANS HOME CARE LLC
Entity Type:Organization
Organization Name:GUARDIANS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TEGIST
Authorized Official - Middle Name:W
Authorized Official - Last Name:EYOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-967-1337
Mailing Address - Street 1:10195 MAIN ST
Mailing Address - Street 2:SUITE# N
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3415
Mailing Address - Country:US
Mailing Address - Phone:703-967-1337
Mailing Address - Fax:703-880-4371
Practice Address - Street 1:10195 MAIN ST
Practice Address - Street 2:SUITE# N
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3415
Practice Address - Country:US
Practice Address - Phone:703-967-1337
Practice Address - Fax:703-880-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-09541251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health