Provider Demographics
NPI:1336927227
Name:GUARDIAN ANGELS BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGELS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:BETHANY
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-879-3321
Mailing Address - Street 1:975 WINDING BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8020
Mailing Address - Country:US
Mailing Address - Phone:678-270-8812
Mailing Address - Fax:770-234-4145
Practice Address - Street 1:4233 PLEASANT HILL RD STE 110
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1609
Practice Address - Country:US
Practice Address - Phone:770-559-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home