Healthcare Provider Details

I. General information

NPI: 1336927227
Provider Name (Legal Business Name): GUARDIAN ANGELS BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 PLEASANT HILL RD STE 110
DULUTH GA
30096-1609
US

IV. Provider business mailing address

975 WINDING BRIDGE WAY
DULUTH GA
30097-8020
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-0550
  • Fax:
Mailing address:
  • Phone: 678-270-8812
  • Fax: 770-234-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN BETHANY GIBBS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 470-879-3321