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General NPI Number Information
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NPI Number | 1730457458
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Entity Type | Organization
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Legal Business Name | GEORGIA COMMUNITY LIVING FACILITIES LLC
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 500 LANIER AVE W STE 610
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7644
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Country | US
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Telephone | 404-829-2715
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Fax | 678-817-5909
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Provider Business Mailing Address
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Address Line | 500 LANIER AVE W STE 610
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7644
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Country | US
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Telephone | 404-829-2715
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Fax | 678-817-5909
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. RHONDA ANN CROCKETT
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Credential |
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Telephone | 404-829-2715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 007876
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License Number State | GA
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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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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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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 | 007874
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License Number State | GA
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