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General NPI Number Information
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NPI Number | 1679924195
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Entity Type | Organization
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Legal Business Name | GUARDIAN ANGELS OF THE UPSTATE
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 117 FAIRVIEW POINTE DR
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City | SIMPSONVILLE
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State | SC
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Zip | 29681
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Country | US
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Telephone | 404-242-7633
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Fax |
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Provider Business Mailing Address
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Address Line | 117 FAIRVIEW POINTE DR
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3223
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Country | US
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Telephone | 404-242-7633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JIMETTA LITTLEJOHN
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Credential |
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Telephone | 404-242-7633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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