| NPI | 1588943922 |
|---|---|
| Other Name | JACK |
| Entity Type | Organization |
| Authorized Contact | JENNIFER D LOZANO Director 404-364-2900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2015-09-16 |