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General NPI Number Information
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NPI Number | 1417198458
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Entity Type | Organization
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Legal Business Name | NACIEMA CORPORATION
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Dates
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Enumeration Date | 03/22/2009
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Last Update Date | 03/22/2009
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Provider Practice Location Address
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Address Line | 3200 STONE RD SW APT W8
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City | ATLANTA
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State | GA
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Zip | 30331-2920
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Country | US
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Telephone | 678-847-1353
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 STONE RD SW APT W8
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City | ATLANTA
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State | GA
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Zip | 30331-2920
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Country | US
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Telephone | 678-847-1353
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARY ANN SLADE
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Credential |
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Telephone | 678-847-1353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation 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 | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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