# OVERCOMERS YOUTH RESIDENTIAL HOME

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

## Provider details

- **NPI number:** 1417647413
- **Authorized official:** MARCIA WEEKS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (678) 887-3907

## Contact information

- **Practice address:** 115 E MAIN ST, BUFORD, GA 30518-5727
- **Practice address phone:** (678) 887-3907
- **Mailing address:** 780 JAMES RIDGE DR, LAWRENCEVILLE, GA 30045-6800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | — |
| 251G00000X | Community Based Hospice Care Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | — | NULL | Yes |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 05/11/2023
- **Last updated:** 05/11/2023