Provider Demographics
NPI:1801921663
Name:GUARDIAN HOSPICE OF MA, INC.
Entity type:Organization
Organization Name:GUARDIAN HOSPICE OF MA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOSPICE ADMIN & VP
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARLIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN CHPN
Authorized Official - Phone:781-341-1711
Mailing Address - Street 1:1214 PARK ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3738
Mailing Address - Country:US
Mailing Address - Phone:781-341-1711
Mailing Address - Fax:781-341-1775
Practice Address - Street 1:1214 PARK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3738
Practice Address - Country:US
Practice Address - Phone:781-341-1711
Practice Address - Fax:781-341-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221556251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0608424Medicaid
NY02646353Medicaid
MA0610925Medicaid
MA0610917Medicaid
MA0610917Medicaid
MA22-1556Medicare PIN