Organization
BELLVIEW1CLA
Active
Other names
BellviewPCH,LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. OLIVIA GRAHAM FULLER (CEO)
(912) 884-5474
Entity
Organization
Contact information
Practice address
1552 FORT MORRIS RD, MIDWAY, GA 31320-6213
(912) 884-6899
(912) 884-6898
Mailing address
1552 FORT MORRIS RD, MIDWAY, GA 31320-6213
(912) 884-6899
(912) 884-6898
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
CLA
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
519076033B
—
GA
Enumeration date
08/29/2012
Last updated
08/29/2012
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