| NPI | 1154936037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAWFORD KELLY MCDONALD Manager 706-270-1605 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2020-09-09 |