MEDICARE: FRAGMENTS MINISTRY, 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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	082412	OTHER	GA	GEORGIA ASSOCIATION OF RECOVERY RESIDENTS MEMBER STANDARDS
2	102612	OTHER	GA	CERTIFIED BY THE STATE OF GA TO OPERATE AS A SUPPORTIVE HOUSING FACILITY

General Provider Information

NPI Number	:	1689926750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRAGMENTS MINISTRY, INC

Provider Business Mailing Address
First Line	:	5793 JAMES RD
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-4505
Country	:	US
Telephone Number	:	678-598-0651
Fax Number	:	404-755-3237

Provider Business Practice Location Address
First Line	:	635 PEARCE ST SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-2829
Country	:	US
Telephone Number	:	404-755-3237
Fax Number	:	404-755-3237

Authorized Official
Title or Position	:	EXECTIVE DIRECTOR
Name	:	MR. GERALD LEON CLOUD
Credential	:	MINISTER
Telephone Number	:	678-598-0651

Provider Enumeration Date	:	10/12/2012
Last Update Date	:	10/12/2012

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Directions to “FRAGMENTS MINISTRY, INC ” Practice Location

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