Organization
OCTAVIA HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NADINE A PHILLIPS (DIRECTOR)
(404) 429-1752
Entity
Organization
Contact information
Practice address
105 GENEVIEVE CT, FAYETTEVILLE, GA 30215-4803
(404) 429-1752
Mailing address
105 GENEVIEVE CT, FAYETTEVILLE, GA 30215-4803
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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