| NPI | 1376805630 |
|---|---|
| Former Legal Business Name | PROVIDENCE PRIVATE CARE HOME AND PROVIDENCE COMMUNITY LIVING ARRANGEM |
| Entity Type | Organization |
| Authorized Contact | STELLA NGOZI OKPALA Director/Owner 404-931-7854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 060-R-1019) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2012-06-13 |