| NPI | 1427447093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWANDA WORTHY Administrator 770-652-8317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: GA 1400010943) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2015-01-20 |