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General NPI Number Information
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NPI Number | 1538444666
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGELS ADULT LIVING LLC
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 207 KITE LAKE RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-9608
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Country | US
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Telephone | 770-666-4401
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Fax |
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Provider Business Mailing Address
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Address Line | 207 KITE LAKE RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-9608
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Country | US
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Telephone | 770-666-4401
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. BRITTANEY SHONTERIA HESTER
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Credential |
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Telephone | 770-666-4401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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