Organization
HABERSHAM RETREAT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD L MOORE (C.E.O.)
(706) 778-1749
Entity
Organization
Contact information
Practice address
258 PARK AVE, BALDWIN, GA 30511-2329
(706) 778-1749
Mailing address
258 PARK AVE, BALDWIN, GA 30511-2329
(706) 778-1749
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00316346A
—
GA
05
—
00316346B
—
GA
05
—
00316346C
—
GA
05
—
00316346D
—
GA
05
—
00316346E
—
GA
05
—
00316346F
—
GA
Enumeration date
01/23/2007
Last updated
11/14/2017
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