Provider Demographics
NPI:1922604982
Name:GUARDIAN CARE SERVICES LLC
Entity Type:Organization
Organization Name:GUARDIAN CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:MAIA
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-863-7570
Mailing Address - Street 1:1102 RAY CHARLES BLVD UNIT 619
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3059
Mailing Address - Country:US
Mailing Address - Phone:813-863-7570
Mailing Address - Fax:
Practice Address - Street 1:1102 RAY CHARLES BLVD UNIT 619
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3059
Practice Address - Country:US
Practice Address - Phone:813-863-7570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities