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General NPI Number Information
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NPI Number | 1447650601
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Entity Type | Organization
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Legal Business Name | A CHERISHED LIFE, ENRICHMENT CENTER
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 6453 SPRING ST
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-1866
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Country | US
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Telephone | 678-214-5955
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6036
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City | DOUGLASVILLE
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State | GA
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Zip | 30154-0018
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Country | US
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Telephone | 678-214-5955
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. RASHEEDA WHITAKER
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Credential |
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Telephone | 678-214-5955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 054957964
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License Number State | GA
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