Provider Demographics
NPI:1033164306
Name:GUARDIAN ANGEL NETWORK, INC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:ALGINA
Authorized Official - Last Name:BRADLEY-KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:912-351-6801
Mailing Address - Street 1:7 OGLETHORPE PROFESSIONAL BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3608
Mailing Address - Country:US
Mailing Address - Phone:912-351-6801
Mailing Address - Fax:912-351-6805
Practice Address - Street 1:7 OGLETHORPE PROFESSIONAL BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3608
Practice Address - Country:US
Practice Address - Phone:912-351-6801
Practice Address - Fax:912-351-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2295930251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health