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General NPI Number Information
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NPI Number | 1386921336
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Entity Type | Organization
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Legal Business Name | CHESTNUT MANOR, INC.
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 8673 CHESTNUT LN
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-3410
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Country | US
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Telephone | 770-920-9369
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Fax |
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Provider Business Mailing Address
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Address Line | 8673 CHESTNUT LN
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-3410
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. SHIRLEY NAPIER-BRADY
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Credential |
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Telephone | 770-920-9369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 12040
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 12040
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License Number State | GA
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Taxonomy #3
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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 | 12040
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License Number State | GA
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