Organization
ALLEGIANT SERVICE LLC
Active
Organization
ALLEGIANT SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY ANN FERGUSON (ADMINISTRATOR)
(678) 491-6215
Entity
Organization
Contact information
Practice address
4323 JUNEBERRY CT, DECATUR, GA 30034-6425
(678) 491-6215
(770) 558-1580
Mailing address
4323 JUNEBERRY CT, DECATUR, GA 30034-6425
(770) 558-1580
(770) 558-1580
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
126168557A
GA
Other
Enumeration date
02/12/2010
Last updated
02/12/2010
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