Organization
MAIN STREET RESIDENTIAL LIVING
Active
Organization
MAIN STREET RESIDENTIAL LIVING
Active
Other names
Main Street Residential Living, Main St
Organization subpart
No
Provider details
NPI number
Authorized official
CHRYSTAL YORK (OWNER/ADMINISTRATOR)
(912) 658-9238
Entity
Organization
Contact information
Practice address
615 W MAIN ST, THOMASTON, GA 30286-3580
(912) 658-9238
Mailing address
PO BOX 3469, PEACHTREE CITY, GA 30269-7469
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/03/2017
Last updated
06/16/2018
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