Organization
CAMELLIA THERAPEUTIC FOSTER AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH APPIAH (CHIEF EXECUTIVE OFFICER)
(706) 392-3331
Entity
Organization
Contact information
Practice address
407 S SEALE RD, PHENIX CITY, AL 36869-7304
(706) 392-3331
(334) 298-8599
Mailing address
407 S SEALE RD, P.O. BOX 788, PHENIX CITY, AL 36869-7304
(706) 392-3331
(334) 298-8599
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
034627
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339089024
—
AL
01
—
339091102
EDS/SDHR339000000
AL
01
—
339091202
EDS/SDHR339000000
AL
Enumeration date
12/21/2009
Last updated
12/21/2009
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