Organization Name: | NEW ABUNDANT LIVING PCH LLC |
NPI Number: | 1033593553 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIARA BARBER-BOYNES (ADMINISTRATOR/OWNER) |
Mailing Address: | 3887 Sable Dr Stone Mountain |
State: | GA US |
Postal Code: | 300834443 |
Phone Number: | 4042905029 |
Fax Number: | |
NPI Enumeration Date: | 07/14/2015 |
NPI Last Update Date: | 07/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |