| NPI | 1346302197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER D LOZANO Director Of Revenue Cycle 404-968-2663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded (Licence: NC MHL-041-105) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL-041-105) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2015-09-19 |