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Organization
DEVEREUX FOUNDATION
Active
Organization
DEVEREUX FOUNDATION
Active
Other names
Devereux Georgia Treatment Network
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO BOLIVAR JR. (EXECUTIVE DIRECTOR)
(687) 303-2669
Entity
Organization
Contact information
Practice address
1291 STANLEY RD NW, KENNESAW, GA 30152-4359
(770) 427-0147
Mailing address
1283 KENNESTONE CIR, SUITE 100, MARIETTA, GA 30066-6029
(770) 427-0147
(770) 423-1502
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
5910
GA
Other
Enumeration date
11/07/2006
Last updated
01/16/2009
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