Organization
EXQUISITE TRADITIONS
Active
Organization
EXQUISITE TRADITIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE BALLIF (CEO)
(404) 525-9500
Entity
Organization
Contact information
Practice address
7265 MOUNT ZION BLVD, JONESBORO, GA 30236-2519
(404) 525-9500
(404) 393-9436
Mailing address
2045 MOUNT ZION RD, SUITE 397, MORROW, GA 30260-3313
(404) 525-9500
(404) 393-9436
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
PCH001261
GA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
PCH001261
GA
Other
Enumeration date
06/20/2011
Last updated
06/20/2011
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