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General NPI Number Information
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NPI Number | 1730816828
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Entity Type | Organization
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Legal Business Name | GOOD LANDING RECOVERY DETOX AND RESIDENTIAL. LLC
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 4141 OLD CORNELIA HWY
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City | GAINESVILLE
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State | GA
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Zip | 30507-7784
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Country | US
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Telephone | 770-450-6120
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Fax | 770-353-9469
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Provider Business Mailing Address
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Address Line | 256 MCMILLAN RD
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City | DACULA
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State | GA
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Zip | 30019-2337
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Country | US
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Telephone | 770-450-6120
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Fax | 770-353-9569
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT PEARSON LEWIS III
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Credential |
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Telephone | 770-353-9660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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