| NPI | 1316374192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA MOYD Administrator 706-339-6749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: GA 146305913A) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: GA 146305913B) |
| Enumeration Date | 2013-10-10 |
| Last Update Date | 2013-10-10 |