| NPI | 1750795480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMILL ALEAHA MALLORY Co Director 770-996-0775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2014-06-20 |