Organization
CHAUNCY MONTGOMERY
Active
Other names
The Secret Place
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHAUNCY DENETTE MONTGOMERY (OWNER/DIRECTOR)
(912) 347-2399
Entity
Organization
Contact information
Practice address
1114 JR ROLLINS RD, VIDALIA, GA 30474-9462
(912) 537-4143
(912) 537-4143
Mailing address
1114 JR ROLLINS RD, VIDALIA, GA 30474-9462
(912) 537-4143
(912) 537-4143
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
GA
385H00000X
Respite Care
—
GA
Other
Enumeration date
10/01/2010
Last updated
10/01/2010
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