| NPI | 1912138454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERI D. CARGILL Director 678-697-0575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2010-03-12 |