Organization
LOWES GUARDIAN ANGEL LLC
Active
Organization
LOWES GUARDIAN ANGEL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN ALAN LOWE BA (DDP)
(404) 808-4859
Entity
Organization
Contact information
Practice address
7056 EUNICE DR., RIVERDALE, GA 30274
(678) 586-3171
Mailing address
7056 EUNICE DR, RIVERDALE, GA 30274-3152
(678) 586-3171
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
251911340
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
251911340
DBHDD DEVELOPMENTAL DISABILITIES PROVIDER
GA
Enumeration date
01/26/2012
Last updated
01/26/2012
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