| NPI | 1083749568 |
|---|---|
| Other Name | BENTON LANE |
| Entity Type | Organization |
| Authorized Contact | JENNIFER D LOZANO Director Of Revenue Cycle 404-364-2900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2018-09-24 |