| Organization Name: | GREENRIDGE COMMUNITY INTEGRATION HOME |
| NPI Number: | 1023235587 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RALPH SALANDY (MANAGER) |
| Mailing Address: | 508 Greenridge Cir Stone Mountain |
| State: | GA US |
| Postal Code: | 30083 |
| Phone Number: | 4045869230 |
| Fax Number: | |
| NPI Enumeration Date: | 04/19/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 044232 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |