| NPI | 1588031769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWANDA WORTHY Administrator 678-741-5315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2015-08-24 |