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General NPI Number Information
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NPI Number | 1508102005
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Entity Type | Organization
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Legal Business Name | GROUP HOMES FOR THE DISABLED, L.L.C.
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Dates
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Enumeration Date | 01/02/2013
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 3275 IDLECREEK CT
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City | DECATUR
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State | GA
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Zip | 30034-4914
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Country | US
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Telephone | 678-508-3983
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Fax | 404-448-4696
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Provider Business Mailing Address
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Address Line | 624 PAGE AVE NE
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City | ATLANTA
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State | GA
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Zip | 30307-1734
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Country | US
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Telephone | 678-508-3983
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Fax | 404-448-4696
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. ASHLEY T JOSEPH
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Credential | CRC
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Telephone | 678-508-3983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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