| NPI | 1467741710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTEL LONG CEO 678-699-4919 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: GA 033013339) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: GA 033013339) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2011-04-06 |