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Organization

KELLY'S LIFE CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TERESSA DOUGLAS (OWNER)
(404) 228-7985
Entity
Organization

Contact information

Practice address
3895 TOLLIVER HILLS DR, ELLENWOOD, GA 30294-1209
(404) 228-7985
(404) 963-7812
Mailing address
1616 COLUMBIA DR, DECATUR, GA 30032-4613
(404) 228-7985
(404) 963-7812

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
031012958
GA
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
031012958
GA

Other

Enumeration date
11/03/2010
Last updated
11/03/2010
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