Organization
BRIARLAKE COMMUNITY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TASHUA GRIZZLE (ADMINISTRATOR)
(404) 212-4676
Entity
Organization
Contact information
Practice address
1714 BRIARLAKE CIR, DECATUR, GA 30033-1110
(404) 633-5251
(404) 728-1518
Mailing address
1714 BRIARLAKE CIR, DECATUR, GA 30033-1110
(404) 633-5251
(404) 728-1518
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
044232
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000954324J
—
GA
Enumeration date
12/27/2006
Last updated
08/18/2009
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