Organization
PROVIDENCE CARE INC
Active
Organization
PROVIDENCE CARE INC
Active
Other names
providence private care home and providence community living arrangem
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STELLA NGOZI OKPALA PHARM.D (DIRECTOR/OWNER)
(404) 931-7854
Entity
Organization
Contact information
Practice address
216 NW BROAD ST STE B, FAIRBURN, GA 30213-4106
(678) 489-2069
(678) 489-8627
Mailing address
216 NW BROAD ST STE B, FAIRBURN, GA 30213-4106
(678) 489-2069
(678) 489-8627
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
060-R-1019
GA
Other
Enumeration date
06/13/2012
Last updated
06/13/2012
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