Healthcare Provider Details

I. General information

NPI: 1356642334
Provider Name (Legal Business Name): CELESTIAL CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6571 VALLEY HILL DR SW
MABLETON GA
30126-5151
US

IV. Provider business mailing address

6571 VALLEY HILL DR SW
MABLETON GA
30126-5151
US

V. Phone/Fax

Practice location:
  • Phone: 770-948-0709
  • Fax: 770-948-3109
Mailing address:
  • Phone: 770-948-0709
  • Fax: 770-948-3109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number033011031
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number033011031
License Number StateGA

VIII. Authorized Official

Name: MRS. CELESTINE B HARRIS
Title or Position: CEO
Credential:
Phone: 770-948-0709