| NPI | 1871656504 |
|---|---|
| Other Name | TAR RIVER |
| Entity Type | Organization |
| Authorized Contact | JENNIFER LOZANO Director Of Revenue Cycle 404-968-2663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC MHL-074-030) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-074-030) |
| Enumeration Date | 2006-12-17 |
| Last Update Date | 2015-09-19 |