MEDICARE: CHRIST THE KING DAY HABILITATION SERVICES, INC.

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	261QA0600X	Adult Day Care Clinic/Center
2	373H00000X	Day Training/Habilitation Specialist	20065203	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518004217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRIST THE KING DAY HABILITATION SERVICES, INC.

Provider Business Mailing Address
First Line	:	5155 SCOFIELD RD
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-3301
Country	:	US
Telephone Number	:	404-767-4171
Fax Number	:	404-559-8804

Provider Business Practice Location Address
First Line	:	5155 SCOFIELD RD
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-3301
Country	:	US
Telephone Number	:	404-767-4171
Fax Number	:	404-559-8804

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. AUGUSTINA GIBSON
Credential	:
Telephone Number	:	404-767-4171

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/19/2022

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