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General NPI Number Information
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NPI Number | 1891181335
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Entity Type | Organization
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Legal Business Name | FIRST LADY RESIDENTIAL SERVICE LLC
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 401 BARNHILL DR
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City | SAVANNAH
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State | GA
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Zip | 31406-5912
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Country | US
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Telephone | 912-508-3363
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Fax | 912-925-5515
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Provider Business Mailing Address
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Address Line | 401 BARNHILL DR
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City | SAVANNAH
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State | GA
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Zip | 31406-5912
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Country | US
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Telephone | 912-508-3363
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Fax | 912-925-5515
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | MRS. DEBORAH ANN GANT
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Credential |
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Telephone | 912-508-3363
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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 |
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License Number State |
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