1154470490 NPI number — GUARDIAN HOME CARE, INC

Table of content: (NPI 1154470490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154470490 NPI number — GUARDIAN HOME CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUARDIAN HOME CARE, INC
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:
ENHABIT HOSPICE OF IDAHO
Provider Other Organization Name Type Code:
3
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:
1154470490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6688 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
SUITE 1300
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-3950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-239-6500
Provider Business Mailing Address Fax Number:
214-239-6581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 S WHITLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRUITLAND
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83619-2542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-452-4972
Provider Business Practice Location Address Fax Number:
208-452-4974
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARLISLE
Authorized Official First Name:
CRISSY
Authorized Official Middle Name:
BUCHANAN
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
214-239-6500

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000010153410 . This is a "REGENCE OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 806662800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: H0372 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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