Organization · Type 2 NPI

Georgia Department of Human Resources

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Hephzibah, GA

NPI number 1912075904 Active

Practice location

3004 Cromwell Ct
Hephzibah, GA 30815-6212

Call (706) 790-2034 Map

Mailing address

100 Myrtle Blvd
Gracewood, GA 30812-1500

Specialties and licenses

TaxonomyCodeLicense
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary 320900000XNA (GA)

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.

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About NPI 1912075904

Georgia Department of Human Resources's National Provider Identifier is 1912075904, issued on Nov 30, 2006. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Hephzibah, GA. The record was last updated on Aug 22, 2020.