Guardian Angels Hospice,LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

0440430H Issued in GA

Legal business name

GUARDIAN ANGELS HOSPICE,LLC

Practice address

3469 Lawrenceville Hwy
203
Tucker, GA 30084-5888

Phone

(470) 242-5682

NPI assigned

Nov 2, 2016

Organization subpart

Yes

Parent organization

GUARDIAN ANGELS HOSPICE,LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tamekia Fuller

Title

Owner

Phone

(470) 242-5682

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Hospice certification: CCN 111793

Legal name

GUARDIAN ANGELS HOSPICE,LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Nov 16, 2017

Last certification

Apr 21, 2021

Ownership / control type

Proprietary - Other

Organization structure

LLCProprietary

Incorporated

Mar 25, 2015 in GA

Enrollment address

3469 Lawrenceville Hwy
Ste 203
Tucker, GA 30084-5866

Listed as

Guardian Angels HospiceCCN 111793

Ownership

For-Profit

Certified

Nov 16, 2017

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Guardian Angels Hospicellc

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Jean Joseph Philippe-Dambreville, MD

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1639177066

  W-2 Managing Employee

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Harlan Luke South, MD

  • Internal Medicine Physician
  • San Francisco, CA
  • NPI 1750438099

  Hospice

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478044800000",
    "number": "1144772435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3469 LAWRENCEVILLE HWY",
            "address_2": "203",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845888",
            "telephone_number": "470-242-5682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3469 LAWRENCEVILLE HWY",
            "address_2": "203",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845888",
            "telephone_number": "470-242-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGELS HOSPICE,LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUARDIAN ANGELS HOSPICE,LLC",
        "enumeration_date": "2016-11-02",
        "last_updated": "2016-11-02",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "TAMEKIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "470-242-5682"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": "0440430H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakia Griffin
• Nia Charnice Griffin, NP
• Elizabeth Ann Grigsby, APRN
• Madison Grove
• Nicole Gualandi
• Guardian Health Group
• Gwinnett Clinic, LTD
• Heather Helen Hale, LMT
• Lillian Haley
• Tara Hall

• Community Based Hospice Care Agency in Tucker, GA
• Providers in Tucker, GA by specialty
• Community Based Hospice Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.