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General NPI Number Information
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NPI Number | 1437375672
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Entity Type | Organization
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Legal Business Name | CREW STREET COMMUNITY INTEGRATION HOME
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 885 CREW ST SW
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City | ATLANTA
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State | GA
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Zip | 30315-1540
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Country | US
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Telephone | 404-586-9260
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Fax |
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Provider Business Mailing Address
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Address Line | 885 CREW ST SW
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City | ATLANTA
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State | GA
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Zip | 30315-1540
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Country | US
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Telephone | 404-586-9260
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RALPH SALANDY
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Credential |
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Telephone | 404-819-0901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 044232
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License Number State | GA
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