Healthcare Provider Details

I. General information

NPI: 1386974681
Provider Name (Legal Business Name): COMMUNITIES IN ACTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 PEACHTREE ST SUITE 2200
ATLANTA GA
30303-1202
US

IV. Provider business mailing address

260 PEACHTREE ST SUITE 2200
ATLANTA GA
30303-1202
US

V. Phone/Fax

Practice location:
  • Phone: 404-527-6247
  • Fax: 404-527-6201
Mailing address:
  • Phone: 404-527-6247
  • Fax: 404-527-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ANDREA LEWIS
Title or Position: CFO
Credential: BAQP
Phone: 919-328-0318