Organization
ULTIMATE LIVING SERVICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD DAVID TILLMAN ED.D (DIRECTOR)
(404) 401-1094
Entity
Organization
Contact information
Practice address
1516 CROOKED TREE CIR, STONE MOUNTAIN, GA 30088-3723
(404) 401-1094
Mailing address
1516 CROOKED TREE CIR, STONE MOUNTAIN, GA 30088-3723
(404) 401-1094
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
044017288
GA
Other
Enumeration date
10/09/2009
Last updated
10/09/2009
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