Provider Demographics
NPI:1538388459
Name:GUARDIAN HOSPICE INC
Entity type:Organization
Organization Name:GUARDIAN HOSPICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-517-5546
Mailing Address - Street 1:1527 W 13TH ST
Mailing Address - Street 2:STE E
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1527 W 13TH ST
Practice Address - Street 2:STE E
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2985
Practice Address - Country:US
Practice Address - Phone:909-920-1192
Practice Address - Fax:909-920-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY492813336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5626645OtherNCPDP PROVIDER IDENTIFICATION NUMBER