| NPI | 1558632968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM KENNETH WHIDDON COO 912-638-0350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: GA CLA000694 P) |
| Enumeration Date | 2012-01-17 |
| Last Update Date | 2012-01-17 |