Organization
EMPOWERMENT OF DIVINE PROVIDENCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLORISSAL LIU (OWNER)
(404) 285-8415
Entity
Organization
Contact information
Practice address
3 BIRCHFIELD WAY, DALLAS, GA 30132-0842
(404) 285-8415
Mailing address
3 BIRCHFIELD WAY, DALLAS, GA 30132-0842
(404) 285-8415
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
GA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
CN0030003852
GA
Other
Enumeration date
09/14/2011
Last updated
10/31/2014
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