# OCTAVIA HOUSE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225372998
- **Authorized official:** NADINE A PHILLIPS (DIRECTOR)
- **Authorized official phone:** (404) 429-1752

## Contact information

- **Practice address:** 105 GENEVIEVE CT, FAYETTEVILLE, GA 30215-4803
- **Practice address phone:** (404) 429-1752
- **Mailing address:** 105 GENEVIEVE CT, FAYETTEVILLE, GA 30215-4803

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | — | — | Yes |

## Other

- **Enumeration date:** 11/20/2012
- **Last updated:** 11/20/2012