| NPI | 1669191144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURETTA KOOPER Program Manager 678-656-5605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2022-08-26 |