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General NPI Number Information
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NPI Number | 1912230905
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Entity Type | Organization
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Legal Business Name | TLB RESIDENTIAL TREATMENT SERVICES, INC.
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 1000 EXECUTIVE CT STE C
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City | WARNER ROBINS
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State | GA
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Zip | 31093-3185
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Country | US
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Telephone | 678-518-9764
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Fax |
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Provider Business Mailing Address
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Address Line | 3404 EASTMONT LN
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City | LITHONIA
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State | GA
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Zip | 30038-2789
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Country | US
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Telephone | 770-559-3836
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS FRANCENE LUMPKIN
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Credential |
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Telephone | 770-559-3836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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