| NPI | 1598914095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE ENNIS MCGEE Manager 678-445-4833 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: IL A-0538-0003-A) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility (Licence: IL A-0538-0003-A) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL A-0538-0003-A) | |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2021-12-28 |