1003848573 NPI number — GUARDIAN HOME CARE MID-CUMBERLAND, LLC

Table of content: (NPI 1003848573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003848573 NPI number — GUARDIAN HOME CARE MID-CUMBERLAND, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUARDIAN HOME CARE MID-CUMBERLAND, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003848573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 HWY 327 EAST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILSBEE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-385-5228
Provider Business Mailing Address Fax Number:
409-385-4322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 MATHIS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DICKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37055-7038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-441-1747
Provider Business Practice Location Address Fax Number:
615-441-3621
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BISHOP
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
409-385-5228

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  0000000074 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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