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Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANDRICK TERRELL (OWNER/ORGANIZATION DIRECTOR)
(706) 338-5091
Entity
Organization

Contact information

Practice address
575 BETHANY CT, ATHENS, GA 30606-1659
(706) 338-5091
Mailing address
575 BETHANY CT, ATHENS, GA 30606-1659
(706) 338-5091

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
BT-0091403
GA

Other

Enumeration date
03/03/2011
Last updated
03/03/2011
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