| NPI | 1679856629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNE B MIMS Owner 478-750-7747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: GA 25896382) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 311ZA0620X Custodial Care Facility Adult Care Home | |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2011-09-27 |