Organization Name: | SID'S PLACE INCORPORATED |
NPI Number: | 1174823595 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ZANNIE DARRELL BLACK (OWNER) |
Mailing Address: | 2742 Luke Dr Ellenwood |
State: | GA US |
Postal Code: | 302943987 |
Phone Number: | 6785578969 |
Fax Number: | 4045214888 |
NPI Enumeration Date: | 11/01/2010 |
NPI Last Update Date: | 11/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | 031012928 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
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. |