Organization
DERICHE AGENCY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE KING (ADMINISTRATOR)
(678) 478-1029
Entity
Organization
Contact information
Practice address
3175 CHEROKEE ST NW, KENNESAW, GA 30144-2829
(678) 490-3761
(678) 601-6445
Mailing address
3175 CHEROKEE ST NW, KENNESAW, GA 30144-2829
(678) 490-3761
(678) 601-6445
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271472802A
—
GA
Enumeration date
12/07/2009
Last updated
11/30/2015
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