Provider Demographics
NPI:1831533355
Name:GUARDIAN HEALTHCARE CENTERS
Entity type:Organization
Organization Name:GUARDIAN HEALTHCARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-361-1882
Mailing Address - Street 1:39 STEVENSVILLE CUTOFF RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-6496
Mailing Address - Country:US
Mailing Address - Phone:406-361-1882
Mailing Address - Fax:206-892-9678
Practice Address - Street 1:39 STEVENSVILLE CUTOFF RD
Practice Address - Street 2:SUITE A
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-6496
Practice Address - Country:US
Practice Address - Phone:406-361-1882
Practice Address - Fax:206-892-9678
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NUWAY2P4U LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-26
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT9901548Medicaid