Organization
GEORGIA COMMUNITY LIVING FACILITIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RHONDA ANN CROCKETT (OWNER/PRESIDENT)
(404) 829-2715
Entity
Organization
Contact information
Practice address
500 LANIER AVE W STE 610, FAYETTEVILLE, GA 30214-7644
(404) 829-2715
(678) 817-5909
Mailing address
500 LANIER AVE W STE 610, FAYETTEVILLE, GA 30214-7644
(404) 829-2715
(678) 817-5909
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
007876
GA
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
007874
GA
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
12/08/2011
Last updated
03/29/2013
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