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General NPI Number Information
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NPI Number | 1922967017
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Entity Type | Organization
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Legal Business Name | IRIE COMMUNITY LIVING LLC
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/18/2026
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Provider Practice Location Address
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Address Line | 729 S JEFF DAVIS DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-2416
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Country | US
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Telephone | 943-237-2892
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Fax |
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Provider Business Mailing Address
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Address Line | 805 GLYNN ST S STE 127 PMB #196
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2077
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Country | US
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Telephone | 943-237-2892
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KESHIA KIRTZ
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Credential | LMSW
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Telephone | 943-237-2892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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