| NPI | 1134564131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL A TAVARES Director 770-322-6810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2013-05-03 |