Provider Demographics
NPI:1578378428
Name:GUARDIAN HOME SUPPORT LLC
Entity type:Organization
Organization Name:GUARDIAN HOME SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAKHTAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARSAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-228-1419
Mailing Address - Street 1:316 LAUDENBACH CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4667
Mailing Address - Country:US
Mailing Address - Phone:320-291-5652
Mailing Address - Fax:
Practice Address - Street 1:316 LAUDENBACH CT APT 102
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4668
Practice Address - Country:US
Practice Address - Phone:320-291-5652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health