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General NPI Number Information
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NPI Number | 1578190450
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Entity Type | Organization
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Legal Business Name | FOUR-SIXTY INC
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 4300 MARTHA BERRY HWY NE
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City | ROME
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State | GA
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Zip | 30165-8642
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Country | US
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Telephone | 678-834-7615
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Fax |
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Provider Business Mailing Address
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Address Line | 460 BERKSHIRE PL
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City | FAIRBURN
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State | GA
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Zip | 30213-2069
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Country | US
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Telephone | 832-454-8506
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. NORWOOD N RICHARDSON
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Credential | ESQ
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Telephone | 832-454-8506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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