Organization
SOUTHERN INTERNATIONAL LIVING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MINNIE LEE WARD CNA (DIRECTOR)
(404) 684-6884
Entity
Organization
Contact information
Practice address
3437 MOUNT OLIVE RD, EAST POINT, GA 30344-5812
(404) 547-1291
(404) 551-3549
Mailing address
3437 MOUNT OLIVE RD, EAST POINT, GA 30344-5812
(404) 684-6884
(404) 551-3549
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
CLA000974
GA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
CLA001010
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181308327A
—
GA
Enumeration date
07/09/2009
Last updated
05/12/2012
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