Provider Demographics
NPI:1841221140
Name:GUARDIAN HOME CARE OF CENTRAL GEORGIA, LLC
Entity Type:Organization
Organization Name:GUARDIAN HOME CARE OF CENTRAL GEORGIA, LLC
Other - Org Name:ACCENTCARE HOME HEALTH OF CENTRAL 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 1:17855 DALLAS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6852
Mailing Address - Country:US
Mailing Address - Phone:972-267-1100
Mailing Address - Fax:972-267-1115
Practice Address - Street 1:1551 JENNINGS MILL RD UNIT 2500A
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7274
Practice Address - Country:US
Practice Address - Phone:706-354-6073
Practice Address - Fax:706-354-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029279H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA334739498AMedicaid
GA117145Medicare Oscar/Certification