Organization
A CERTAIN LAD MINISTRIES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORY JERMAINE MARSHALL (CHIEF EXECUTIVE OFFICER)
(770) 282-4273
Entity
Organization
Contact information
Practice address
693 SHANNON WAY, LAWRENCEVILLE, GA 30044-6310
(678) 698-5227
Mailing address
693 SHANNON WAY, LAWRENCEVILLE, GA 30044-6310
(678) 698-5227
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
03/25/2020
Last updated
03/25/2020
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