Organization
THE MARY WASHINGTON ASSISTED LIVING HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAWANA GRAY (CEO)
(770) 469-0155
Entity
Organization
Contact information
Practice address
590 MOUNTAIN OAKS PKWY, STONE MOUNTAIN, GA 30087-4732
(770) 469-0155
(770) 469-0155
Mailing address
590 MOUNTAIN OAKS PKWY, STONE MOUNTAIN, GA 30087-4732
(770) 469-0155
(770) 469-0155
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
044018141
GA
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
044018141
GA
Other
Enumeration date
11/12/2010
Last updated
11/12/2010
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