Individual provider · Type 1 NPI
Marthalene Logan
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Bethlehem, GA
Practice location
4514 Yorktown Dr
Bethlehem, GA 30620-4826
Mailing address
250 North Ave
Athens, GA 30601-2244
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary | 320900000X | None listed |
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
About NPI 1700289048
Marthalene Logan's National Provider Identifier is 1700289048, issued on Oct 1, 2014. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Bethlehem, GA. The record was last updated on Oct 1, 2014.