Organization
SHALLOWFORD GROUP HOME
Active
Parent organization
DEKALB COMMUNITY SERVICE BOARD
Other names
Shallowford Group Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
DEKALB COMMUNITY SERVICE BOARD
Authorized official
FABIO BRUNO VAN DER MERWE (COO)
(404) 294-3836
Entity
Organization
Contact information
Practice address
2473 SHALLOWFORD RD NE, ATLANTA, GA 30345-1363
(404) 636-0955
(404) 636-0955
Mailing address
445 WINN WAY FL 4, DECATUR, GA 30030-1707
(404) 508-7796
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/20/2007
Last updated
08/19/2024
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