Healthcare Provider Details

I. General information

NPI: 1518004217
Provider Name (Legal Business Name): CHRIST THE KING DAY HABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 SCOFIELD RD
COLLEGE PARK GA
30349-3301
US

IV. Provider business mailing address

5155 SCOFIELD RD
COLLEGE PARK GA
30349-3301
US

V. Phone/Fax

Practice location:
  • Phone: 404-767-4171
  • Fax: 404-559-8804
Mailing address:
  • Phone: 404-767-4171
  • Fax: 404-559-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number20065203
License Number StateGA

VIII. Authorized Official

Name: MRS. AUGUSTINA GIBSON
Title or Position: DIRECTOR
Credential:
Phone: 404-767-4171