Provider Demographics
NPI:1841504511
Name:MELINDAS GUARDIAN ANGEL PERSONAL CARE HOME
Entity type:Organization
Organization Name:MELINDAS GUARDIAN ANGEL PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MECHELLE
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-558-2116
Mailing Address - Street 1:1301 DIANNE WAY
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-5621
Mailing Address - Country:US
Mailing Address - Phone:678-558-2116
Mailing Address - Fax:678-963-2761
Practice Address - Street 1:593 EIGHTH ST
Practice Address - Street 2:
Practice Address - City:STATHAM
Practice Address - State:GA
Practice Address - Zip Code:30666-1830
Practice Address - Country:US
Practice Address - Phone:770-725-7407
Practice Address - Fax:678-963-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007010311320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness