Organization
AVALONIA GROUP HOMES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN M. SHORT (CHIEF EXECUTIVE OFFICER)
(864) 836-7220
Entity
Organization
Contact information
Practice address
213 HART CUT RD, MARIETTA, SC 29661-9687
(864) 836-7220
(864) 294-1774
Mailing address
PO BOX 699, MARIETTA, SC 29661-0699
(864) 836-7220
(864) 294-1774
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
SR-0008124001-CC1
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
993MXH
—
SC
Enumeration date
10/27/2006
Last updated
01/12/2009
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