| NPI | 1871978965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA MYERS Clinican 706-861-3387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness (Licence: GA LPN090474) |
| Additional Taxonomies | 310500000X Intermediate Care Facility, Mental Illness (Licence: TN 86290) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2015-07-30 |