| NPI | 1285883710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE ENNIS MCGEE Manager 678-445-4833 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: IL A-0538-0021-A) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: IL A-0538-0021-A) |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: IL C/A-0538-0021-A) | |
| 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children (Licence: IL A-0538-0021-A) | |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2021-12-16 |