MEDICARE: MURIEL'S ASSISTED LIVING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	033011931	GA

General Provider Information

NPI Number	:	1023282951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MURIEL'S ASSISTED LIVING LLC

Provider Business Mailing Address
First Line	:	1630 SONYA DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-5730
Country	:	US
Telephone Number	:	678-576-0189
Fax Number	:	770-977-4097

Provider Business Practice Location Address
First Line	:	2470 WINDY HILL RD SE
Second Line	:	300
City	:	MARIETTA
State	:	GA
Zip	:	30067-8613
Country	:	US
Telephone Number	:	678-576-0189
Fax Number	:	770-977-4097

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LOIS RENEE THOMAS
Credential	:
Telephone Number	:	678-576-0189

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	08/04/2015

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