Provider Demographics
NPI:1639100985
Name:GUARDIAN HOME CARE OF NORTHEAST GEORGIA, LLC
Entity Type:Organization
Organization Name:GUARDIAN HOME CARE OF NORTHEAST GEORGIA, LLC
Other - Org Name:ACCENTCARE HOME HEALTH OF NORTHEAST GEORGIA
Other - Org Type:Doing Business As
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:224-221-0465
Mailing Address - Street 1:5089 BRISTOL INDUSTRIAL WAY STE B
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1780
Mailing Address - Country:US
Mailing Address - Phone:678-450-9950
Mailing Address - Fax:678-450-9930
Practice Address - Street 1:5089 BRISTOL INDUSTRIAL WAY STE B
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1780
Practice Address - Country:US
Practice Address - Phone:678-450-9950
Practice Address - Fax:678-450-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069274H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA117139Medicare Oscar/Certification