Provider Demographics
NPI:1497478929
Name:GUARDIAN PERSONAL CARE SERVICES OF GEORGIA LLC
Entity Type:Organization
Organization Name:GUARDIAN PERSONAL CARE SERVICES OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP LEGAL
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-933-1019
Mailing Address - Street 1:225 W MULBERRY ST
Mailing Address - Street 2:SUITE 102 ATTN MECCA
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201
Mailing Address - Country:US
Mailing Address - Phone:940-220-2074
Mailing Address - Fax:
Practice Address - Street 1:11660 ALPHARETTA HWY STE 440
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3880
Practice Address - Country:US
Practice Address - Phone:770-933-1019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care