Provider Demographics
NPI:1922005057
Name:GUARDIAN HEALTH SERVICES LLC
Entity type:Organization
Organization Name:GUARDIAN HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-324-3025
Mailing Address - Street 1:100 MAIN AVE NW STE 200
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-6200
Mailing Address - Country:US
Mailing Address - Phone:828-324-3025
Mailing Address - Fax:828-324-1930
Practice Address - Street 1:100 MAIN AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6200
Practice Address - Country:US
Practice Address - Phone:828-324-3025
Practice Address - Fax:828-324-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0057251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3417085Medicaid
347085OtherMEDICARE PROVIDER
347085OtherMEDICARE PROVIDER