| NPI | 1992006365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VELMA L JACKSON Owner 706-793-6487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: GA 121013781) |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2010-11-16 |