Organization
DESTINED 4 GREATNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIMMIE L WARREN (EXECUTIVE DIRECTOR)
(404) 597-9490
Entity
Organization
Contact information
Practice address
698 GRAND FOLIA CT, SUGAR HILL, GA 30518-5593
(404) 597-9490
Mailing address
698 GRAND FOLIA CT, SUGAR HILL, GA 30518-5593
(404) 597-9490
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GA
—
GA
Enumeration date
10/16/2012
Last updated
10/16/2012
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