MEDICARE: GIVE THANKS TO GOD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	067014149	GA

General Provider Information

NPI Number	:	1245531615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIVE THANKS TO GOD LLC

Provider Business Mailing Address
First Line	:	3306 SAN ANTONIO DR
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30039-6975
Country	:	US
Telephone Number	:	770-864-1598
Fax Number	:

Provider Business Practice Location Address
First Line	:	3306 SAN ANTONIO DR
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30039-6975
Country	:	US
Telephone Number	:	770-864-1598
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA AIGHOBAHI
Credential	:
Telephone Number	:	770-864-1598

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	11/16/2010

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Directions to “GIVE THANKS TO GOD LLC ” Practice Location

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