Provider Demographics
NPI:1376243881
Name:GUARDIAN ANGELS HOME CARE LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGELS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:N
Authorized Official - Last Name:EXPOSE'
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-406-1129
Mailing Address - Street 1:4416 WAXWING ST
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-5539
Mailing Address - Country:US
Mailing Address - Phone:404-406-1129
Mailing Address - Fax:470-264-1035
Practice Address - Street 1:6668 U S HIGHWAY 98 STE F
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7982
Practice Address - Country:US
Practice Address - Phone:601-336-7987
Practice Address - Fax:470-264-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08809880Medicaid