Organization
HAPEVILLE MANOR ASSISTED LIVING FACILITY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLTON S. WATT (CEO)
(404) 767-5874
Entity
Organization
Contact information
Practice address
601 COLEMAN ST, HAPEVILLE, GA 30354-1041
(404) 767-5874
(404) 305-9461
Mailing address
3752 PRESCOTT RIDGE CIR, CLARKSTON, GA 30021-1664
(404) 767-5874
(404) 305-9461
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
060030111
GA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
060030111
GA
Other
Enumeration date
12/08/2011
Last updated
12/08/2011
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