Organization
GUARDIAN ANGELS OF THE UPSTATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMETTA LITTLEJOHN (OWNER)
(404) 242-7633
Entity
Organization
Contact information
Practice address
117 FAIRVIEW POINTE DR, SIMPSONVILLE, SC 29681
(404) 242-7633
Mailing address
117 FAIRVIEW POINTE DR, SIMPSONVILLE, SC 29681-3223
(404) 242-7633
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
302F00000X
Exclusive Provider Organization
—
—
305R00000X
Preferred Provider Organization
—
—
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
06/27/2016
Last updated
06/27/2016
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