Healthcare Provider Details

I. General information

NPI: 1417198458
Provider Name (Legal Business Name): NACIEMA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2009
Last Update Date: 03/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 STONE RD SW APT W8
ATLANTA GA
30331-2920
US

IV. Provider business mailing address

3200 STONE RD SW APT W8
ATLANTA GA
30331-2920
US

V. Phone/Fax

Practice location:
  • Phone: 678-847-1353
  • Fax:
Mailing address:
  • Phone: 678-847-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY ANN SLADE
Title or Position: PRESIDENT
Credential:
Phone: 678-847-1353