# SECOND NATURE BLUE RIDGE

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

## Provider details

- **NPI number:** 1871706382
- **Authorized official:** ANGIE EVANS (BUSINESS OFFICE)
- **Authorized official phone:** (801) 766-6604

## Contact information

- **Practice address:** 236 FILE STREET, CLAYTON, GA 30525-3023
- **Practice address phone:** (706) 212-2037
- **Practice address fax:** (706) 212-0354
- **Mailing address:** 236 FILE STREET, CLAYTON, GA 30525-3023
- **Mailing address phone:** (706) 212-2037
- **Mailing address fax:** (706) 212-0354

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 50017 | GA | Yes |

## Other

- **Enumeration date:** 05/08/2007
- **Last updated:** 05/29/2012