| NPI | 1063541753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL DELORES SHAW Director 770-593-2539 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2020-08-22 |