Organization
OVERCOMERS YOUTH RESIDENTIAL HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCIA WEEKS (EXECUTIVE DIRECTOR)
(678) 887-3907
Entity
Organization
Contact information
Practice address
115 E MAIN ST, BUFORD, GA 30518-5727
(678) 887-3907
Mailing address
780 JAMES RIDGE DR, LAWRENCEVILLE, GA 30045-6800
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251G00000X
Community Based Hospice Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
05/11/2023
Last updated
05/11/2023
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