Organization
MONIX CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN MONIX (CEO)
(770) 771-1559
Entity
Organization
Contact information
Practice address
1901 BOULDER GATE DR, ELLENWOOD, GA 30294-1680
(770) 771-1559
Mailing address
1901 BOULDER GATE DR, ELLENWOOD, GA 30294-1680
(770) 771-1559
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
044017532
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
931572633A
—
GA
Enumeration date
06/15/2010
Last updated
06/15/2010
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