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General NPI Number Information
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NPI Number | 1346952850
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Entity Type | Organization
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Legal Business Name | RED TOP WELLNESS CENTER
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 5 BOWEN CT
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City | CARTERSVILLE
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State | GA
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Zip | 30120-2493
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Country | US
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Telephone | 770-289-5483
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 440462
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City | KENNESAW
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State | GA
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Zip | 30160-9508
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Country | US
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Telephone | 770-726-2985
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Fax | 678-909-2039
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | MRS. JAIMY BROCK
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Credential |
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Telephone | 678-334-6651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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