Organization
EMERALD ISLES PCH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIAN LAWTON (FACILITY DIRECTOR)
(770) 509-0533
Entity
Organization
Contact information
Practice address
1402 SHADOWBROOK DR, MARIETTA, GA 30062-4032
(770) 509-0533
Mailing address
1402 SHADOWBROOK DR, MARIETTA, GA 30062-4032
(770) 509-0533
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088
—
GA
05
—
244
—
GA
Enumeration date
03/26/2008
Last updated
03/26/2008
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