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General NPI Number Information
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NPI Number | 1073038063
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Entity Type | Organization
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Legal Business Name | RESPITE RETREAT, INC.
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Dates
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Enumeration Date | 08/10/2017
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Last Update Date | 08/10/2017
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Provider Practice Location Address
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Address Line | 1256 OLD GUM LOG RD
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-2065
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Country | US
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Telephone | 706-781-3155
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2703
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City | BLAIRSVILLE
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State | GA
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Zip | 30514-2703
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Country | US
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Telephone | 706-897-4237
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | CHRISTINE OWEN
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Credential | MA
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Telephone | 706-781-3155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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