Healthcare Provider Details

I. General information

NPI: 1134694524
Provider Name (Legal Business Name): REP PERIMETER HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 NORTHWINDS PKWY STE 550
ALPHARETTA GA
30009-2236
US

IV. Provider business mailing address

2520 NORTHWINDS PKWY STE 550
ALPHARETTA GA
30009-2236
US

V. Phone/Fax

Practice location:
  • Phone: 470-554-7903
  • Fax:
Mailing address:
  • Phone: 470-554-7903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: JAMES LAUGHLIN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 470-554-7903