Provider Demographics
NPI:1144540410
Name:GUARDIAN HOME HEALTH, LLC
Entity type:Organization
Organization Name:GUARDIAN HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:KENWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:812-917-5249
Mailing Address - Street 1:1521 S 3RD ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-1011
Mailing Address - Country:US
Mailing Address - Phone:812-917-5249
Mailing Address - Fax:812-917-5042
Practice Address - Street 1:1521 S 3RD ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-1011
Practice Address - Country:US
Practice Address - Phone:812-917-5249
Practice Address - Fax:812-917-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10-012338-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health