Organization
SAFE HARBOUR LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TALIS BURRELL (CEO)
(770) 474-4472
Entity
Organization
Contact information
Practice address
3784 FREMONT DR, ELLENWOOD, GA 30294-6660
(770) 474-4472
(770) 972-1791
Mailing address
3784 FREMONT DR, ELLENWOOD, GA 30294-6660
(770) 474-4472
(770) 972-1791
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
031013099
GA
320700000X
Physical Disabilities Residential Treatment Facility
031013099
GA
Other
Enumeration date
03/22/2011
Last updated
03/22/2011
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