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General NPI Number Information
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NPI Number | 1487883914
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Entity Type | Organization
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Legal Business Name | FAMILY FUSION SERVICES LLC
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 1373 CLEVELAND AVE
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City | EAST POINT
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State | GA
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Zip | 30344-3423
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Country | US
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Telephone | 770-934-4202
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Fax | 404-684-6001
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Provider Business Mailing Address
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Address Line | 1373 CLEVELAND AVE
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City | EAST POINT
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State | GA
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Zip | 30344-3423
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Country | US
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Telephone | 770-934-4202
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Fax | 404-684-6001
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Authorized Official
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Title or Position | C
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Name | P P
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Credential |
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Telephone | 770-934-4202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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