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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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