Organization
GUARDIAN ANGELS ADULT LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRITTANEY SHONTERIA HESTER (ADMINISTRATOR)
(770) 666-4401
Entity
Organization
Contact information
Practice address
207 KITE LAKE RD, FAYETTEVILLE, GA 30214-9608
(770) 666-4401
Mailing address
207 KITE LAKE RD, FAYETTEVILLE, GA 30214-9608
(770) 666-4401
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
10/20/2011
Last updated
10/20/2011
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