Provider Demographics
NPI:1902415391
Name:PURE GUARDIAN CARE LLC
Entity Type:Organization
Organization Name:PURE GUARDIAN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSBAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-729-8227
Mailing Address - Street 1:1441 WOODMONT LN NW STE 2599
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2866
Mailing Address - Country:US
Mailing Address - Phone:404-720-8227
Mailing Address - Fax:
Practice Address - Street 1:2599 CANDLER WAY SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4270
Practice Address - Country:US
Practice Address - Phone:404-720-8228
Practice Address - Fax:404-777-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care