Healthcare Provider Details

I. General information

NPI: 1245464718
Provider Name (Legal Business Name): TLB RESIDENTIAL TREATMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MARTHA STREET
WARNER ROBINS GA
31093
US

IV. Provider business mailing address

4306 DONNA WAY
LITHONIA GA
30038-7718
US

V. Phone/Fax

Practice location:
  • Phone: 478-293-1490
  • Fax:
Mailing address:
  • Phone: 678-518-9764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FRANCENE LUMPKIN
Title or Position: CEO
Credential:
Phone: 770-559-3835