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Organization
PREDESTINED FOR GREATNESS
Active
Organization
PREDESTINED FOR GREATNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DION THOMAS (CEO)
(770) 320-9278
Entity
Organization
Contact information
Practice address
4865 BROOKSTONE PKWY, ELLENWOOD, GA 30294-2126
(770) 320-9278
Mailing address
4865 BROOKSTONE PKWY, ELLENWOOD, GA 30294-2126
(770) 320-9278
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
CCI001578
GA
Other
Enumeration date
05/15/2007
Last updated
08/22/2020
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