| NPI | 1013474915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE PRIOR Billing Supervisor 706-432-4837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2019-02-27 |