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Organization

FRAGMENTS MINISTRY, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GERALD LEON CLOUD MINISTER (EXECTIVE DIRECTOR)
(678) 598-0651
Entity
Organization

Contact information

Practice address
635 PEARCE ST SW, ATLANTA, GA 30310-2829
(404) 755-3237
(404) 755-3237
Mailing address
5793 JAMES RD, AUSTELL, GA 30168-4505
(678) 598-0651
(404) 755-3237

Taxonomy

Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
082412
GEORGIA ASSOCIATION OF RECOVERY RESIDENTS MEMBER STANDARDS
GA
01
102612
CERTIFIED BY THE STATE OF GA TO OPERATE AS A SUPPORTIVE HOUSING FACILITY
GA
Enumeration date
10/12/2012
Last updated
10/12/2012
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