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General NPI Number Information
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NPI Number | 1720382039
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Entity Type | Organization
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Legal Business Name | ROSALENA'S COMMUNITY DEVELOPMENT CENTER INC
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 350 SCHOEN ST SE
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City | ATLANTA
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State | GA
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Zip | 30315-5308
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Country | US
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Telephone | 404-392-4496
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Fax |
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Provider Business Mailing Address
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Address Line | 350 SCHOEN ST SE
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City | ATLANTA
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State | GA
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Zip | 30315-5308
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Country | US
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Telephone | 404-392-4496
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. YALANA YELAINE BARBER
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Credential |
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Telephone | 404-392-4496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 060013711
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License Number State | GA
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