Healthcare Provider Details

I. General information

NPI: 1912230905
Provider Name (Legal Business Name): TLB RESIDENTIAL TREATMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EXECUTIVE CT STE C
WARNER ROBINS GA
31093-3185
US

IV. Provider business mailing address

3404 EASTMONT LN
LITHONIA GA
30038-2789
US

V. Phone/Fax

Practice location:
  • Phone: 678-518-9764
  • Fax:
Mailing address:
  • Phone: 770-559-3836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS FRANCENE LUMPKIN
Title or Position: CEO
Credential:
Phone: 770-559-3836