Organization
PEACE IN YOUNG LIFE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCHELLE MITZI GAINES (CEO/OWNER)
(706) 263-2533
Entity
Organization
Contact information
Practice address
717 E LINE ST, CALHOUN, GA 30701-2271
(706) 629-2212
(706) 629-2213
Mailing address
717 E LINE ST, CALHOUN, GA 30701-2271
(706) 629-2212
(706) 629-6613
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
064010111
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007422496A
—
GA
Enumeration date
09/25/2007
Last updated
02/16/2012
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