Provider Demographics
NPI:1912282039
Name:GUARDIAN ANGELS PRIVATE HOMECARE LLC
Entity Type:Organization
Organization Name:GUARDIAN ANGELS PRIVATE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRITTANEY
Authorized Official - Middle Name:SHONTERIA
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-666-4401
Mailing Address - Street 1:207 KITE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-9608
Mailing Address - Country:US
Mailing Address - Phone:770-666-4401
Mailing Address - Fax:
Practice Address - Street 1:207 KITE LAKE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-9608
Practice Address - Country:US
Practice Address - Phone:770-666-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility