=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629376868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUARDIAN ADLITIEM HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2011
-----------------------------------------------------
Last Update Date | 03/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3350 PEACH ORCHARD RD STE 807
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30906-5932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-664-8373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3350 PEACH ORCHARD RD STE 807
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30906-5932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-664-8373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. LINDA J CURRY
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 706-664-7383
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | LCB20110000312
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------