Lowes Guardian Angel LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

251911340 Issued in GA

Legal business name

LOWES GUARDIAN ANGEL LLC

Practice address

7056 Eunice Dr.
Riverdale, GA 30274

Phone

(678) 586-3171

NPI assigned

Jan 26, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Glenn Alan Lowe, BA

Title

DDP

Phone

(404) 808-4859

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1327536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327536000000",
    "number": "1942571625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7056 EUNICE DR",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302743152",
            "telephone_number": "678-586-3171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7056 EUNICE DR.",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "30274",
            "telephone_number": "678-586-3171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOWES GUARDIAN ANGEL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-26",
        "last_updated": "2012-01-26",
        "status": "A",
        "authorized_official_last_name": "LOWE",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "DDP",
        "authorized_official_telephone_number": "404-808-4859",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "251911340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DBHDD DEVELOPMENTAL DISABILITIES PROVIDER",
            "identifier": "251911340",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.