Provider Demographics
NPI:1124279815
Name:GUARDIAN HEALTHCARE AND HOSPICE,LLC
Entity type:Organization
Organization Name:GUARDIAN HEALTHCARE AND HOSPICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDELLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:846-446-0000
Mailing Address - Street 1:181 WAUKEGAN RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2755
Mailing Address - Country:US
Mailing Address - Phone:847-446-0000
Mailing Address - Fax:
Practice Address - Street 1:181 WAUKEGAN RD
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2755
Practice Address - Country:US
Practice Address - Phone:847-446-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL141630Medicare UPIN