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General NPI Number Information
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NPI Number | 1194403683
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Entity Type | Organization
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Legal Business Name | IES OF GEORGIA LLC
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 496 E 200TH ST
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City | EUCLID
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State | OH
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Zip | 44119-1566
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Country | US
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Telephone | 216-303-2003
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Fax |
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Provider Business Mailing Address
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Address Line | 160 E 267TH ST
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City | EUCLID
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State | OH
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Zip | 44132-1232
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Country | US
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Telephone | 216-315-0533
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. LATIA WORTHY
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Credential |
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Telephone | 216-315-0533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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