| NPI | 1417112707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MOORE Manager 912-393-3466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: GA 034-01-019-8) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2008-07-25 |