MEDICARE: LOVE WITH COMPASSION

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	CLA000780	GA

General Provider Information

NPI Number	:	1699157198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVE WITH COMPASSION

Provider Business Mailing Address
First Line	:	1093 FOREST PATH
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2923
Country	:	US
Telephone Number	:	678-732-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	1093 FOREST PATH
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-2923
Country	:	US
Telephone Number	:	678-732-4443
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YVANE SAINT-FESTIN
Credential	:
Telephone Number	:	678-732-4443

Provider Enumeration Date	:	06/22/2015
Last Update Date	:	06/22/2015

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Directions to “LOVE WITH COMPASSION ” Practice Location

Language	Start Address	Practice Location

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