| NPI | 1700101391 |
|---|---|
| Doing Business As | JACKIE WEST |
| Entity Type | Organization |
| Authorized Contact | WANDA JESSIE Billing Manager 706-432-4858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2010-04-07 |