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General NPI Number Information
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NPI Number | 1164710711
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Entity Type | Organization
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Legal Business Name | EDEN'S HOME OF CARE, LLC
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 3716 NEWHALEM ST SW
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City | ATLANTA
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State | GA
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Zip | 30331-2243
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Country | US
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Telephone | 404-288-2333
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Fax | 404-521-4967
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Provider Business Mailing Address
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Address Line | 3904 N DRUID HILLS RD SUITE 342
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City | DECATUR
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State | GA
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Zip | 30033-3105
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Country | US
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Telephone | 404-288-2333
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Fax | 404-521-4967
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Authorized Official
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Title or Position | CEO
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Name | DR. J BRITNEY WILLIAMS
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Credential | DO
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Telephone | 404-288-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | PCH005676
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | PCH005676
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License Number State | GA
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