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General NPI Number Information
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NPI Number | 1508166927
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Entity Type | Organization
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Legal Business Name | AIDEN'S PLACE , LLC
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 7370 WRIGHT DR
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City | ATLANTA
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State | GA
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Zip | 30349-7911
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Country | US
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Telephone | 404-244-3664
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Fax | 404-393-6420
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Provider Business Mailing Address
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Address Line | 116 FALLING WATERS DR
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City | JONESBORO
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State | GA
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Zip | 30236-5484
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Country | US
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Telephone | 404-244-3664
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Fax | 404-393-6420
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Authorized Official
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Title or Position | OWNER
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Name | MR. CURTIS L. JOHNSON
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Credential |
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Telephone | 404-244-3664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 060013808
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 060013808
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 060013808
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License Number State | GA
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