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

## Provider details

- **NPI number:** 1821455759
- **Authorized official:** VICKIE BURROW-JOHNSON (CEO)
- **Authorized official phone:** (770) 289-3682

## Contact information

- **Practice address:** 5031 GLORE RD SW, MABLETON, GA 30126-5509
- **Practice address phone:** (770) 289-3682
- **Practice address fax:** (678) 321-1464
- **Mailing address:** 5031 GLORE RD SW, MABLETON, GA 30126-5509
- **Mailing address phone:** (770) 289-3682
- **Mailing address fax:** (678) 321-1464

## Taxonomy

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

## Other

- **Enumeration date:** 01/22/2016
- **Last updated:** 01/22/2016