Organization
SOUTHERN COMMUNITY SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA MOORE (MANAGER)
(912) 393-3466
Entity
Organization
Contact information
Practice address
315 S. GASKIN AVE, DOUGLAS, GA 31533
(912) 393-3466
(912) 393-1103
Mailing address
315 S. GASKIN AVE, DOUGLAS, GA 31533
(912) 393-3466
(912) 393-1103
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
034-01-019-8
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290464766A
—
GA
Enumeration date
07/25/2008
Last updated
07/25/2008
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