| NPI | 1063964831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERMAINE LUCIE FOTCHINE NYA CEO 678-882-4389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: VA 2518) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2016-10-27 |