Healthcare Provider Details

I. General information

NPI: 1558277251
Provider Name (Legal Business Name): THE CENTER FOR INCLUSIVE RECREATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 HOSPITAL RD
NEWNAN GA
30263-1209
US

IV. Provider business mailing address

132 HODGES ST
NEWNAN GA
30263-6445
US

V. Phone/Fax

Practice location:
  • Phone: 770-254-3750
  • Fax:
Mailing address:
  • Phone: 770-778-1741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CHANDA MOORE
Title or Position: CEO
Credential:
Phone: 770-778-1741