| NPI | 1316279557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ANN FERGUSON Administrator 678-491-6215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: GA 126168557A) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2010-02-12 |