Organization Name: | GEORGIA COMMUNITY LIVING FACILITIES LLC |
NPI Number: | 1730457458 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RHONDA ANN CROCKETT (OWNER/PRESIDENT) |
Mailing Address: | 500 Lanier Ave W Ste 610 Fayetteville |
State: | GA US |
Postal Code: | 302147644 |
Phone Number: | 4048292715 |
Fax Number: | 6788175909 |
NPI Enumeration Date: | 12/08/2011 |
NPI Last Update Date: | 03/29/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320600000X |
License Number: | 007876 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |