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General NPI Number Information
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NPI Number | 1770974461
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Entity Type | Organization
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Legal Business Name | FAITH OPEN DOOR COMMUNITY CENTER, INC.
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Dates
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Enumeration Date | 02/17/2015
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 259 ARROWHEAD BLVD C2
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City | JONESBORO
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State | GA
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Zip | 30236-1167
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Country | US
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Telephone | 678-545-6053
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Fax | 678-545-6119
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Provider Business Mailing Address
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Address Line | 259 ARROWHEAD BLVD C2
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City | JONESBORO
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State | GA
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Zip | 30236-1167
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Country | US
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Telephone | 678-545-6053
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Fax | 678-545-6119
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Authorized Official
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Title or Position | CEO
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Name | GERALDINE RUIZ
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Credential |
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Telephone | 678-545-6053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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