Organization
AIDEN'S PLACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONDINE D GORDON (CEO)
(770) 573-1076
Entity
Organization
Contact information
Practice address
7370 WRIGHT DR, ATLANTA, GA 30349-7911
(770) 573-1076
(770) 234-5894
Mailing address
1227 ROCKBRIDGE RD, SUITE 208-196, STONE MOUNTAIN, GA 30087-3064
(770) 573-1076
(770) 234-5894
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
PCH008079
GA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
PCH008079
GA
Other
Enumeration date
10/03/2011
Last updated
10/03/2011
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