Organization
SRAINTREE VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD E SANDERS LMSW (ASST. ADMIN.)
(229) 559-5944
Entity
Organization
Contact information
Practice address
3757 JOHNSTON RD, VALDOSTA, GA 31601-2105
(229) 559-5944
Mailing address
3757 JOHNSTON RD, VALDOSTA, GA 31601-2105
(229) 559-5944
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
CPA-40075
GA
Other
Enumeration date
04/09/2007
Last updated
08/22/2020
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