Provider Demographics
NPI:1053353623
Name:GUARDIAN HOMECARE LLC
Entity type:Organization
Organization Name:GUARDIAN HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HEMMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-624-9999
Mailing Address - Street 1:248 W BUTE ST
Mailing Address - Street 2:SUITE #202
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1440
Mailing Address - Country:US
Mailing Address - Phone:757-624-9999
Mailing Address - Fax:757-624-1111
Practice Address - Street 1:248 W BUTE ST
Practice Address - Street 2:SUITE #202
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1440
Practice Address - Country:US
Practice Address - Phone:757-624-9999
Practice Address - Fax:757-624-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X, 3747P1801X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010199000Medicaid
VA010196574Medicaid
VA010199000Medicaid