Provider Demographics
NPI:1649318072
Name:GUARDIAN HEALTH CARE INC
Entity type:Organization
Organization Name:GUARDIAN HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJORY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:LARONGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-942-4417
Mailing Address - Street 1:5405 OLD STATE ROUTE 21
Mailing Address - Street 2:
Mailing Address - City:HOUSE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63051-2439
Mailing Address - Country:US
Mailing Address - Phone:636-942-4417
Mailing Address - Fax:636-942-5997
Practice Address - Street 1:5405 OLD STATE ROUTE 21
Practice Address - Street 2:
Practice Address - City:HOUSE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:63051-2439
Practice Address - Country:US
Practice Address - Phone:636-942-4417
Practice Address - Fax:636-942-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251J00000X, 163WH0200X, 302R00000X, 372500000X, 372600000X, 3747P1801X, 163W00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO262957905Medicaid
MO282957901Medicaid
MO00001152OtherSSBG